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

PURPOSE: This study aims to report a case of tuberculosis involving central nervous system (CNS) discovered thanks to tubercular endophathlmitis. METHODS: This is a case report. OBSERVATION: A 14-year-old male presented with acute visual loss, ocular pain, and redness of the right eye following a recent stay in India. The clinical history was notable for prolonged fever, night sweats, and headache. Ophthalmological examination revealed severe intraocular inflammation consistent with panuveitis and endophthalmitis. Neuroimaging demonstrated a large ring-enhancing lesion in the right hemisphere with significant mass effect. Initial microbiological investigations, including vitreous sampling, were negative. A positive interferon-gamma release assay and radiological findings raised suspicion for disseminated tuberculosis, and Mycobacterium tuberculosis DNA was subsequently detected in vitreous samples after repeating a second vitrectomy. Antitubercular therapy was started and definitive diagnosis was made with biopsy of the brain lesion, which demonstrated positive cultures for drug-sensitive M. tuberculosis. The clinical course was complicated by retinal detachment, paradoxical enlargement of the cerebral tuberculoma, and postoperative neurological deficits requiring surgical intervention and rehabilitation. CONCLUSION: This case highlights the diagnostic complexity of ocular and CNS tuberculosis and emphasizes the need for a high index of suspicion, repeated targeted sampling, and multidisciplinary management to achieve timely diagnosis and appropriate treatment.