When Tuberculin Stings: A Case of Panophthalmitis Following Tuberculin Skin Test

Abstract

To report a case of allergic reaction to a tuberculin skin test that incited a panophthalmitis-like reaction with exudative retinal detachment. Retrospective Chart Review A 38-year-old woman presented with sudden onset ocular pain, redness, and protrusion of both eyes following a tuberculin skin test, part of the investigative process for her recent high-grade fever. On presentation to us, her visual acuity was limited to the perception of light in both eyes. Ophthalmic examination revealed fibrinous anterior chamber reaction, sluggish pupils, diffuse conjunctival chemosis, limited ocular movement in all gazes, and inadequate eyelid closure due to proptosis in both eyes. Fundus examination of both eyes showed grade 3+ vitritis and exudative bullous retinal detachment. All other laboratory investigations were within normal limits. The patient demonstrated a remarkable response to pulse corticosteroid therapy, with significant alleviation of ocular symptoms and partial resolution of inflammation. Further treatment was initiated with oral corticosteroids and mycophenolate mofetil, followed by the addition of cyclosporine, which facilitated complete resolution of the exudative retinal detachment with restoration her BCVA to 6/9. This case underscores the importance of ophthalmologists recognizing that acute allergic reactions secondary to tuberculin skin tests can, on rare occasions, present as uveitis, and highlights the need for appropriate management of such conditions.