Unsuspected mycobacterial endophthalmitis with increased aqueous lactate dehydrogenase levels in a child

A 12-year-old boy had chronic uveitis resistant to medical therapy OS. Clinical examination and serologic tests did not show any infectious or systemic disease. Cytologic study from aqueous paracentesis revealed atypical cells. Ultrasonography disclosed diffuse posterior chorioretinal thickening. The diagnosis of diffuse retinoblastoma was considered, and an aqueous aspirate was assayed for lactate dehydrogenase. It contained six times the level present in a matching sample of serum. The blind eye was enucleated, and pathologic examination showed a necrotizing granulomatous endophthalmitis containing acid-fast bacilli.