A 15-year-old West Indian boy presented with unilateral keratoconjunctivitis (KC), initially misdiagnosed as allergic.
The patient subsequently developed a facial vesicular rash, leading to suspicion of herpes simplex virus infection.
Observation:
Despite negative viral cultures and poor response to antiviral therapy, the KC progressed to bilateral involvement, significantly reducing visual acuity.
Systemic symptoms included fatigue, pyrexia, generalized lymphadenopathy, and a lung mass suggestive of granulomatous disease.
Findings:
A non-caseating granuloma obstructing the bronchus was identified, but acid-fast bacilli were absent in sputum and bronchial washings.
A strongly positive Heaf test indicated tuberculosis (TB).
Implications:
Prompt initiation of anti-tuberculous treatment resulted in rapid resolution of both systemic and ocular manifestations.
This case highlights the importance of considering TB in the differential diagnosis of atypical KC and respiratory symptoms, especially in endemic areas.