Bilateral Bouchut Tuberculoma Complicating Multifocal Tuberculosis: A Case Report

Abstract

Tuberculosis is a serious infection and remains a major cause of worldwide mortality and morbidity. Declared by the World Health Organization (WHO) an "urgent global health problem" in 1993. In Morocco, there are about 25,000 new cases / year. Extra-pulmonary localizations represent 35% of all damage, of which 1 to 2% are ocular damage. The purpose of this clinical case is to underline the value of the ophthalmological examination, retinography as well as fluorescein angiography in the orientation of the diagnosis of tuberculosis. We report the case of a 29-year-old immunocompetent patient, without any notion of tuberculosis contagion, hospitalized for a week in the pulmonology department for management of multifocal tuberculosis associating a microscopy-negative and culture positive pulmonary tuberculosis and multifocal tuberculous spondylodiscitis.  A progressive and bilateral decrease in his visual acuity was reported one week after his hospitalization, prompting an ophthalmological consultation which objectified through fundus examination, retinography and fluorescein angiography the presence of bilateral Bouchut's tuberculoma. The patient is put on antitubercular treatment for a period of nine months associated with corticosteroid therapy and vitamin therapy. In Morocco, tuberculosis continues to surprise as well by its extension affecting the debilitated subject and the immunocompetent subject, as by its various presentations including the ocular involvement that must be sought by a careful and systematic ophthalmological examination. Bouchut's tuberculoma can be a valuable aid in the diagnosis of multifocal tuberculosis by a simple examination of the fundus.