Peeping through the holes: An interesting course of tubercular uveitis

CASE HISTORY A 30-year-old female presented with diminished vision in her right eye. Her best corrected visual acuity (BCVA) was 6/60 OD (Right eye) and 6/6 OS (Left eye). She was on antitubercular therapy for pulmonary Kochs. Her diagnosis was established by bronchoalveolar lavage (BAL) culture and typical computed tomography findings. Right eye examination revealed anterior chamber (AC) reaction +2, Koeppe’s and Busaca’s nodules, along with multiple posterior synechiae, characteristic festooned pupil on attempted dilatation, immature cataract, and grade 2 vitritis. The left eye was unremarkable. Her detailed history was elicited and systemic examination was done to rule out viral and other causes of uveitis. She was put on topical and systemic steroids along with cycloplegics, in addition to her antitubercular therapy. The patient was lost to follow-up. However, she presented 3 months later with quiet AC and multiple, well-defined, irregular but concentric transillumination defects in iris, caused by iris pigment epithelium degeneration and thinning of stroma [Figure 1].Figure 1: Slit lamp image in (a) acute uveitis phase with iris nodules (b) resolved phase with multiple transillumination defectsIris atrophic patches have been seen in Fuchs heterochromic iridocyclitis, Fuchs uveitic syndrome, Vogt-Koyanagi-Harada disease, pigment dispersion syndrome, pseudoexfoliation syndrome, and trauma.[1] Such transillumination defects in tubercular uveitis are rare and, however, have been occasionally reported.[2] Here, we present this unique case of tubercular uveitis which responded well to antitubercular therapy and steroids, resulting in resolution of inflammation, but leaving behind patches of iris atrophy. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.