Anterior Ischemic Optic Neuropathy Revealing Thyroid and Lymph Node Tuberculosis: A Case Report

Tuberculosis is a bacterial infection caused by the Mycobacterium tuberculosis complex, which includes five Mycobacteriums : Tuberculosis (commonly known as Koch's Bacillus), Bovis, Africanum, Microti, and Pinnipedii. This condition affects both humans and certain animal species (such as cattle). Human contamination occurs either via respiratory or digestive routes, with four possible outcomes: early-onset of the tuberculosis disease, late-onset of it, latent tuberculosis infection, or the total elimination of the bacillus. It can affect both immunocompetent and immunodeficient individuals, and when the disease manifests, it may be unifocal or multifocal, leading to clinical polymorphism that complicates the diagnostic process. We report the case of a patient, who had contact with livestock (the wife of a farmer who owns cattle), with no known immunodeficiency, vaccinated against tuberculosis, and in whom bifocal tuberculosis was diagnosed following an etiological assessment of anterior ischemic optic neuropathy. This represents a presentation undescribed previously, with the following atypical features: bifocal localization in an immunocompetent patient vaccinated against tuberculosis, the unusual thyroid involvement, the identification of Mycobacterium Bovis, and the fact that this inaugural presentation has not been previously documented in the medical literature.