Can the TB-LAM Test Be a Valuable Tool in Ophthalmology? A Case of Probable Ocular Tuberculosis in an Immunocompromised Patient
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Yes
Purpose
To highlight the diagnostic utility of the lipoarabinomannan (TB-LAM) test in identifying probable extrapulmonary tuberculosis (TB) in an immunocompromised patient presenting with ocular manifestations and to discuss its potential application in ophthalmology.
Methods
A 32-year-old woman presented with a five-day history of bilateral decreased vision. She appeared emaciated but denied systemic symptoms such as fever or respiratory complaints. Ophthalmologic examination revealed visual acuity reduced to hand motion bilaterally, pale optic discs, diffuse retinal pallor, no anterior segment inflammation, and minimal vitreous cells. Systemic evaluation identified severe anemia (hemoglobin: 4 g/dL) and advanced HIV immunosuppression (CD4 count: 40 cells/mm³). Imaging studies ruled out pulmonary TB, but a urine TB-LAM test was positive. Aqueous humor was collected for TB-LAM analysis, but the sample volume was insufficient. The patient received RHZE therapy, antiretrovirals, and prednisone, and outcomes were monitored.
Results
Following TB treatment and corticosteroids, the patient improved, with resolution of retinal vasculitis and reduction of macular edema. The clinical findings, along with a positive TB-LAM test in urine, supported probable ocular TB despite no pulmonary involvement.
Conclusion
This case highlights the relevance of TB-LAM testing as a complementary diagnostic tool for extrapulmonary TB in patients with advanced HIV. Its high specificity and established use in systemic TB raise the possibility of applying this test to ophthalmology.
Conflict of interest
No
1
Last name
PEREIRA
Initials of first name(s)
LH
Department
Department of Ophthalmology and Visual Sciences - Federal University of São Paulo
City
Sao Paulo
Country
Brazil
2
Last name
Franco
Initials of first name(s)
PLC
Department
Department of Ophthalmology and Visual Sciences - Federal University of São Paulo
City
Sao Paulo
Country
Brazil
3
Last name
Cavalcante
Initials of first name(s)
JLV
Department
Department of Ophthalmology and Visual Sciences - Federal University of São Paulo
City
Sao Paulo
Country
Brazil
4
Last name
Stähelin
Initials of first name(s)
JA
Department
Department of Infectology - Federal University of São Paulo
City
Sao Paulo
Country
Brazil
5
Last name
Souza
Initials of first name(s)
CE
Department
Department of Ophthalmology and Visual Sciences - Federal University of São Paulo
City
Sao Paulo
Country
Brazil
6
Last name
Ferreira
Initials of first name(s)
PRA
Department
Department of Infectology - Federal University of São Paulo
City
Sao Paulo
Country
Brazil
7
Last name
Finamor
Initials of first name(s)
LP
Department
Department of Ophthalmology and Visual Sciences - Federal University of São Paulo
City
Sao Paulo
Country
Brazil
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