Bilateral choroidal tuberculoma in miliary tuberculosis - report of a case

Abstract

BackgroundA choroidal mass or granuloma is a feature of ocular tuberculosis (TB). Tubercles can arise in the early stages of progression of TB and indicate hematogenous dissemination before the development of symptomatic disease. Tubercular subretinal granuloma is responsive to treatment with anti-tuberculosis therapy, and prompt treatment helps resolve the lesion completely.FindingsWe report a case of a solitary large active choroidal tuberculoma in one eye and multiple healed tubercles in the other. The patient was an immunocompetent girl with splenic and miliary TB and had a relatively asymptomatic systemic status. Aqueous humor analysis by polymerase chain reaction (PCR) and real-time PCR (RT-PCR) was negative for the Mycobacterium tuberculosis genome. Based on clinical history and investigations, treatment with four-drug regimen of anti-tubercular treatment with concomitant corticosteroids was started, and total healing of the lesion occurred in 3 months.ConclusionsThis case highlights the fact that in some patients, analysis of the aqueous may not provide any clue to the confirmation of an active tubercular choroidal granuloma and an association between splenic tuberculosis and choroidal tubercles has never been reported in the past.

Bilateral multiple choroidal granulomas and systemic vasculitis as presenting features of tuberculosis in an immunocompetent patient

“…A rare case of bilateral multiple choroidal granulomas with splenic involvement and miliary tuberculosis has been reported which also had pulmonary involvement [6]. The analysis of the aqueous in their case did not provide any clue to the confirmation of tubercular choroidal granuloma [6]. However, in our case; aqueous tap proved the diagnosis by PCR for MPB 64 which was positive.…”

“…Ocular involvement in disseminated tuberculosis is seen commonly with choroidal tubercles [5]. A rare case of bilateral multiple choroidal granulomas with splenic involvement and miliary tuberculosis has been reported which also had pulmonary involvement [6]. The analysis of the aqueous in their case did not provide any clue to the confirmation of tubercular choroidal granuloma [6].…”

“…Pulmonary tuberculosis is the commonest systemic manifestation of the disease but without radiological evidence of pulmonary involvement or acid fast bacilli positivity in sputum, confirmation of ocular tuberculosis becomes difficult. It is an uncommon presentation to have disseminated disease without pulmonary involvement [6]. …”

Disseminated Tuberculosis among Adult Patients Admitted to Hamad General Hospital, Qatar: A Five Year Hospital Based Study

“…Meningitis was found in 23 (23%) of our patients, which falls within the range of 10-30% mentioned in the literature [3,13,14]. Choroidal tubercles are pathognomonic of disseminated TB and offer a valuable clue to the diagnosis [14,15]. In our patients, there was no mention of the frequency of choroidal tubercles since funduscopic examinations were not routinely performed.…”

Tuberculous Subretinal Abscess in a Non-HIV Patient with Miliary Tuberculosis

“…It develops from liquefaction necrosis from caseous material of large tuberculomas [3]. Tuberculomas can be seen in patients with miliary TB [4, 5, 6, 7], tuberculous central nervous system involvement [8, 9, 10], TB of the spine [4], and immunosuppressed patients [11, 12]. It has also been reported in association with AIDS, and a minimal inflammatory reaction may be observed when it occurs [13].…”