Uveitis developing in tuberculous lymphadenitis-associated Behçet's disease during anti-tuberculosis therapy

Area of Science:

• Immunology
• Infectious Diseases
• Ophthalmology

Background:

• Behçet's disease (BD) pathogenesis is unclear, but tuberculosis (TB) infection is a suspected trigger in genetically susceptible individuals.
• Seven cases of BD potentially triggered by TB have been documented, with symptom improvement post-TB treatment.
• Ocular involvement in BD can significantly impair quality of life if not diagnosed and treated promptly.

Observation:

• A 46-year-old woman with tuberculous lymphadenitis developed uveitis two months after initiating TB treatment.
• The patient presented with oral ulcers, genital ulcers, and erythema nodosum-like lesions.
• Simultaneous lymphadenopathy relapse and retinal findings on fluorescein angiography suggested a paradoxical reaction to TB therapy.

Findings:

• This case represents the first report of uveitis occurring during anti-TB therapy.
• The uveitis was likely a paradoxical reaction to TB treatment, indicated by disease relapse.
• Extrapulmonary TB is more frequently associated with paradoxical reactions involving ocular complications.

Implications:

• Physicians must consider ocular involvement, such as uveitis, as a potential complication during anti-TB therapy, especially in extrapulmonary cases.
• Early recognition and management of paradoxical reactions are crucial to prevent irreversible vision loss.
• This highlights the complex interplay between infections, immune responses, and autoimmune conditions like Behçet's disease.