# Rare bilateral corneoscleral perforation secondary to ocular tuberculosis: a case report and clinical insights

## TL;DR

A 27-year-old patient presented with rare bilateral corneoscleral perforation linked to ocular tuberculosis, highlighting the importance of considering this condition in similar clinical scenarios.

## Contribution

This case report highlights the rare bilateral corneoscleral perforation caused by ocular tuberculosis confirmed via a positive IGRA test.

## Key findings

- Bilateral corneoscleral perforation was observed in a patient with presumed ocular tuberculosis.
- A positive interferon-γ release assay (IGRA) supported the diagnosis of tuberculosis despite negative results for other infectious and rheumatologic tests.
- Treatment with intravenous methylprednisolone and a six-month tuberculosis regimen was initiated.

## Abstract

This case represents a rare presentation of bilateral corneoscleral perforation secondary to presumed ocular mycobacterium tuberculosis infection with the goal of reporting a case of bilateral corneoscleral perforation in the setting of a positive interferon-γ release assay (IGRA) test.

A 27-year-old patient presented with five months of redness, worsening eye pain, and five days of decreasing vision. Visual acuity (VA) was counting fingers bilaterally. Intraocular pressure (IOP) was 10 mmHg and 19 mmHg in the right and left eye, respectively. A slit lamp examination disclosed conjunctival injection, corneal haze, bilateral mutton-fat keratic precipitates, and a hypopyon in both eyes. The right eye had a 1.5 mm × 1.5 mm Seidel-positive corneal perforation with uveal prolapse. Similarly, the left eye had a 0.5 mm × 0.5 mm Seidel-negative inferior corneal perforation with uveal plugging. The chest X-ray showed a left-sided pleural effusion.

Computed tomography (CT) of the face and sinuses showed bilateral circumferential globe thickening. IGRA was positive. All other rheumatologic and infectious workups were negative, including HIV, ACE, ANA, ANCA, CRP, anti-scleroderma antibody and HCV. The patient was treated with intravenous methylprednisolone and seven months of rifampin, isoniazid, pyrazinamide, and ethambutol. This workup shows the rare bilateral corneal involvement of ocular tuberculosis.