Rare presentation of intractable tuberculous panophthalmitis with intraocular and intraorbital abscesses: a case report

J Med Case Rep. 2017 Jul 4;11(1):180. doi: 10.1186/s13256-017-1353-9.


Background: We report a rare presentation of extrapulmonary tuberculosis.

Case presentation: A 29-year-old Burmese woman with human immunodeficiency virus infection and known pulmonary tuberculosis who had been treated for 5 months presented to our hospital with unilateral progressive painful visual loss of 1 month's duration. She was diagnosed with tuberculous panophthalmitis with subretinal and intraorbital abscesses, conjunctival abscess, and extraocular muscle tuberculoma. The diagnosis was confirmed by a conjunctival pus swab with a positive result for acid-fast bacilli and a positive result for a mycobacterial culture. There was high suspicion of multidrug-resistant tuberculosis. Despite receiving ongoing aggressive treatment with conventional antituberculous medications, this patient required subtotal orbital exenteration to control her infection and prevent further progression. Second-line antituberculous medications were added to the first-line therapy, with satisfactory results achieved.

Conclusions: Tuberculous panophthalmitis with intraocular and intraorbital abscesses is a rare presentation of extrapulmonary tuberculosis. Patients who do not respond to first-line antituberculous therapy might be infected with either single-drug or multidrug-resistant Mycobacterium tuberculosis. Patient compliance is one of the key factors that can alter the course of treatment. Careful patient monitoring can improve disease progression, outcome, and prognosis.

Keywords: Extrapulmonary tuberculosis; Tuberculous orbital abscess; Tuberculous panophthalmitis.

Publication types

  • Case Reports

MeSH terms

  • AIDS-Related Opportunistic Infections / physiopathology*
  • Abscess / microbiology
  • Adult
  • Antitubercular Agents / therapeutic use*
  • Disease Progression
  • Female
  • Humans
  • Medication Adherence
  • Panophthalmitis / drug therapy
  • Panophthalmitis / microbiology*
  • Panophthalmitis / physiopathology
  • Tuberculosis, Ocular / drug therapy
  • Tuberculosis, Ocular / microbiology*
  • Tuberculosis, Ocular / physiopathology
  • Vision Disorders / drug therapy
  • Vision Disorders / microbiology*
  • Vision Disorders / physiopathology


  • Antitubercular Agents