背景:眼部结核(TB)影响1-2%的TB患者,结核性葡萄膜炎是最常见的。本系列旨在研究结核病相关葡萄膜炎的不同表现以及用于推定或确定诊断的不同测试。
方法:回顾了2017年至2020年在香港特区诊断为结核病相关葡萄膜炎的患者。人口统计,临床特征,收集患者的调查和治疗。
结果:纳入10例平均年龄57.30±10.17岁患者的15只眼。眼部表现包括前葡萄膜炎(50%),后葡萄膜炎(40%)和全葡萄膜炎(10%),其中70%是单侧感染,30%是双侧感染;在随后的访问中,表现进一步发展为后葡萄膜炎(40%),全葡萄膜炎(40%)和前葡萄膜炎(20%),其中50%是单侧感染,50%是双侧感染。在7项Mantoux测试中,有5项结核病测试呈阳性,4个T-SPOTTB测试中的4个,4个QuantiFERON-TB金测试中有3个,1个淋巴结活检,9张胸部X光片中有0张,并且没有检测到水性流体聚合酶链反应(PCR)。在6例最常见的视网膜血管炎患者中发现了视力损害并发症。对9名患者进行了抗结核治疗,5例患者出现副作用,包括高眼压,椎间盘肿胀,和肝炎。
结论:眼部结核感染可能表现为多种形式,并且可以涉及眼睛的不同部位。结核病的双边参与是常见的,每次随访时都要对双眼进行评估。当患者怀疑有结核病时,诊断确认需要多模式检查,如果胸部X线阴性无法排除眼结核感染,尤其是在像香港这样的地方。在这些患者中,对结核病的怀疑指数很高是至关重要的,即使他们没有表现出典型的呼吸道体征和结核病症状。
BACKGROUND: Ocular tuberculosis (TB) affects 1-2% of patients with TB, with TB uveitis being the most common. This series aims to look at different manifestations of tuberculosis associated uveitis and the different tests used to make a presumptive or definitive diagnosis.
METHODS: Patients diagnosed with TB related uveitis in Hong Kong SAR between 2017 and 2020 were reviewed. Demographics, clinical features, investigations and treatments of patients were collected.
RESULTS: Fifteen eyes in 10 patients with a mean age 57.30 ± 10.17 years were included. The ocular manifestations on presentation included anterior uveitis (50%), posterior uveitis (40%) and panuveitis (10%), where 70% of them were unilateral and 30% were bilaterally infected; on subsequent visits the manifestations further developed into posterior uveitis (40%), panuveitis (40%) and anterior uveitis (20%), where 50% of them were unilateral and 50% bilateral infected. Tuberculosis tests were positive in 5 out of 7 Mantoux tests, 4 out of 4 T-SPOT TB tests, 3 out of 4 QuantiFERON-TB gold tests, 1 out of 1 lymph node biopsy, 0 out of 9 chest x-rays, and no aqueous fluid polymerase chain reaction (PCR) was tested. Vision impairing complications were seen in 6 patients where retinal vasculitis was most commonly seen. With anti-TB treatment prescribed in 9 patients, side effects occurred in 5 patients, including ocular hypertension, disc swelling, and hepatitis.
CONCLUSIONS: Ocular TB infections may manifest in various forms, and can involve different parts of the eye. Bilateral involvement of TB is commonly presented, and both eyes should be evaluated at every follow up. When TB is suspected in a patient, diagnostic confirmation requires multimodal investigations where a negative chest x-ray is not useful in ruling out ocular TB infections, especially in an endemic region like Hong Kong. In these patients, it is crucial to have a high index of suspicion for TB, even when they do not demonstrate classical respiratory signs and symptoms of TB.