Mooren-like Peripheral Ulcerative Keratitis Associated with Pulmonary Tuberculosis: A Case Report

Abstract

Introduction: Peripheral ulcerative keratitis (PUK) represents a severe inflammatory disorder characterized by progressive stromal thinning and epithelial ulceration of the peripheral cornea. Although it is most frequently associated with autoimmune diseases such as rheumatoid arthritis or systemic vasculitis, infectious agents may act as triggering factors. Tuberculosis remains an important cause of immune-mediated ocular inflammation in endemic areas. Tuberculosis-associated PUK may clinically mimic Mooren’s ulcer, making diagnosis challenging. Early recognition is essential because appropriate anti-tubercular therapy combined with anti-inflammatory treatment may prevent severe visual loss. Case Presentation: We report the case of a 43-year-old woman followed in the pulmonology department for pulmonary tuberculosis who presented with painless redness and decreased vision in the left eye. Ophthalmologic examination revealed visual acuity limited to counting fingers, conjunctival hyperemia, and a crescent-shaped temporal peripheral corneal ulcer measuring 5 × 4 mm with positive fluorescein staining and surrounding stromal edema. The anterior chamber was quiet and the contralateral eye was normal. Tuberculin skin testing and interferon-gamma release assay were positive. A diagnosis of Mooren-like peripheral ulcerative keratitis associated with tuberculosis was suspected. Management and Outcome: The patient received standard six-month anti-tubercular therapy combined with topical lubrication, prophylactic antibiotics, and systemic corticosteroids. Clinical evolution was favorable with progressive epithelial healing and complete corneal re-epithelialization after two months of treatment. At the final follow-up, a residual peripheral corneal scar was present and best-corrected visual acuity improved to 2/10. Conclusion: Tuberculosis-associated Mooren-like ulcer is a rare but important cause of peripheral ulcerative keratitis. Because the clinical presentation may mimic autoimmune corneal diseases, a thorough etiological investigation is necessary. Early diagnosis and combined anti-tubercular and anti-inflammatory therapy are essential to prevent severe corneal destruction and visual impairment.