Choroidal tuberculoma as a presenting sign of tuberculosis

Abstract

Choroidal tuberculoma is a rare ocular form of tuberculosis (TB) that raises both a diagnostic and a therapeutical challenge, especially when occurring without other manifestations of the disease. This study reports the case of a 27-year-old woman who had a unilateral drop of vision (20/100) with ocular pain. Her fundus examination revealed an elevated juxtapapillary choroidal mass measuring 892 µm in diameter, as calculated by optical coherence tomography (OCT), and associated with a serous retinal detachment involving the macula. The diagnosis of choroidal tuberculoma was established by positive QuantiFERON-TB and tuberculin skin test. Laboratory and imaging workup ruled out pulmonary and systemic TB as well as other possible etiologies. Antituberculosis therapy was started and led to an improved visual acuity (20/30) and a shrinkage of the tuberculoma to a diameter of 499 µm at 3 months. This is one of the few reported cases of solitary choroidal tuberculoma in a patient with no other sign of TB. It sheds light on the place of OCT in the diagnosis and follow-up of the choroidal mass, in terms of measuring the size of the mass and revealing the associated serous retinal detachment and the distinctive “contact sign” between the neurosensory retina and the retinal pigment epithelium (RPE)–choriocapillaris layer surmounting the tuberculoma.

A Rare Initial Presentation of Miliary Tuberculosis

“…Ocular TB is a rare presentation (1% of all cases of TB) and can involve any part of the eye [1]. The most common intraocular manifestations of tubercular posterior uveitis include multiple choroidal tubercles and, less commonly, as a large solitary tuberculoma located at the posterior pole [2], which was seen in our case. Moreover, a solitary tuberculoma is often seen in the chronic course of the disease and, uncommonly, as the initial manifestation of miliary tuberculosis.…”

A Rare Case of Optic Neuritis by Relapse of Choroidal Tuberculoma

“…11 Rapid multiplication of bacilli in tuberculoma can lead to serous exudative retinal detachment. 12 The inflammatory changes and retinal changes are minimal in a patient with acquired immunodeficiency. 13 Ocular involvement of tuberculosis can occur due to direct infection (hematogenous spread) or indirectly due to immune-mediated hypersensitivity reaction.…”

“…Prompt diagnosis and systemic treatment with first line anti tubercular therapy (ATT) can lead to visual recovery and involution of choroidal tuberculoma to a flat inactive scar. 12 ATT regimen comprising isoniazid, rifampin, pyrazinamide, and ethambutol for a total of 6-12 months has been accepted as standard therapy. 1,7,10,12 Ethambutol was replaced by Levofloxacin due to ocular side effects associated with ethambutol.…”

“…12 ATT regimen comprising isoniazid, rifampin, pyrazinamide, and ethambutol for a total of 6-12 months has been accepted as standard therapy. 1,7,10,12 Ethambutol was replaced by Levofloxacin due to ocular side effects associated with ethambutol. With clinical evidence of response, the 2-month initiation phase should be followed by 4-month of consolidation phase (isoniazid and rifampin).…”

Infectious uveitis: an Asian perspective

“…There may be blocked fluorescence due to the overlying hemorrhages. On ICGA, subretinal abscesses appear hypofluorescent throughout the early as well as late phase [30][31][32]. OCT is useful in detecting exudative retinal detachment associated with choroidal granulomas [28,33].…”