Autoimmune keratitis in mycobacterium tuberculosis

PURPOSE: To report a case of autoimmune keratitis in a patient with mycobacterium tuberculosis (MBT). METHODS: An 84-year-old male with pulmonary tuberculosis (TB) was admitted with chronic, non-healing bilateral ulcerations of the inferior peripheral cornea associated with stromal and subconjunctival nodules. RESULTS: Clinical examination revealed circumscribed peripheral corneal ulceration with whitish nodules in adjacent stromal and subconjunctival tissue. Microbiological cultures of the corneal tissue were negative for MBT and other microbial pathogens; however, enzyme-linked immunosorbent assay (ELISA) of blood and corneal samples showed significantly elevated levels of IgM and IgA against MBT. In addition to systemic anti-tuberculosis therapy, the patient was treated topically with Polyspectran(®) eye drops, Dexamethasone eye drops, and Bepanthen(®) ointment, for 2 weeks. Both eyes showed dramatic improvement after 2 weeks. CONCLUSION: The present report demonstrates that MBT is able to initiate delayed autoimmune response within the corneal tissue during an intensive phase of anti-tuberculosis treatment.