ENDOPHTHALMITIS INDUCED BY ATYPICAL MYCOBACTERIAL INFECTION

Granulomatous uveitis induced by Mycobacterium tuberculosis infection has been less frequently encountered over the last 20 years. Different ial diagnosis of M. tuberculosis and other atypical mycobacteria is ne vertheless of particular interest in patients with acquired immune def iciency syndromes. We present the case of a 60-year-old man who was re ferred to our clinic because of therapy-refractive endophthalmitis. Di agnostic vitrectomy including microbiological examination as well as f urther extensive serological examinations did not reveal any further i nformation on the etiology. Despite intensive anti-inflammatory treatm ent, the eye became blind and developed secondary glaucoma. Eviscerati on of the globe had to be performed. Histopathological examination sho wed a granulomatous inflammation without the tuberculosis-typical deve lopment of central caseous necrosis. Further molecular pathological in vestigations had to be performed with regard to differential diagnosti c aspects. By means of the polymerase chain reaction we could detect m ycobacterial gene sequences that corresponded to atypical mycobacteria . The diagnosis of atypical mycobacterial infection was confirmed. Mol ecular-genetics examination techniques, especially those involving the polymerase chain reaction, will become more important in routine hist opathological examination. These techniques can be performed on paraff in-fixed or formalin-embedded material for further differential diagno stic considerations.