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When the Eye Reveals Disseminated Tuberculosis: A Pediatric Case of Endophthalmitis With Severe CNS Involvement

Nicola De Santi1, Laura Curci2, Eduardo Bianchi1

  • 1Department of Medicine Surgical, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy, unipg.it.

Case Reports in Ophthalmological Medicine
|August 7, 2026
PubMed

Insights

Ocular tuberculosis (endophthalmitis) led to the diagnosis of central nervous system (CNS) tuberculosis in a teen. Prompt, repeated sampling and multidisciplinary care are crucial for this rare presentation.

Area of Science:

  • Ophthalmology
  • Neurology
  • Infectious Diseases

Background:

  • Tuberculosis can affect the central nervous system (CNS), but concurrent ocular involvement is rare.
  • Disseminated tuberculosis presents diagnostic challenges, particularly when involving multiple organ systems.

Purpose of the Study:

  • To report a rare case of central nervous system (CNS) tuberculosis.
  • To highlight the diagnostic pathway initiated by tubercular endophthalmitis.

Main Methods:

  • Case report of a 14-year-old male with visual loss and neurological symptoms.
  • Utilized ophthalmological examination, neuroimaging, interferon-gamma release assay, vitreous sampling, and brain biopsy for diagnosis.
  • Initiated antitubercular therapy and managed complications.

Main Results:

  • Diagnosis of CNS tuberculosis was confirmed via positive Mycobacterium tuberculosis cultures from a brain lesion biopsy.
  • Mycobacterium tuberculosis DNA was detected in vitreous samples after repeat vitrectomy.
  • The patient experienced complications including retinal detachment and paradoxical tuberculoma enlargement.

Conclusions:

  • Ocular and CNS tuberculosis require a high index of suspicion for timely diagnosis.
  • Repeated targeted sampling and a multidisciplinary approach are essential for effective management.
  • Early diagnosis and treatment are critical for improving outcomes in disseminated tuberculosis.
Abstract

Keywords:
central nervous system tuberculosiscerebral tuberculomaextrapulmonary tuberculosisocular tuberculosispanuveitispediatric tuberculosistuberculosistuberculous endophthalmitis

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