Reactivation of Multifocal Choroiditis Associated with Treatment in Latent Tuberculosis

Abstract

Tuberculosis (TB) causes significant morbidity and mortality worldwide. Ocular manifestations of TB can lead to severe and sight-threatening complications. Initiating treatment in ocular TB with anti-tubercular therapy (ATT) may be necessary to prevent long-term visual complications. We present a case of the reactivation of bilateral multifocal choroiditis (MFC) in a patient with latent TB after commencing ATT. An asymptomatic 36-year-old Indian male was referred to an ophthalmologist with extensive inactive bilateral MFC close to his fovea despite no previous medical or ocular history. Latent TB was subsequently diagnosed via TB specific antigens and antibodies. After a period of stable observation without evidence of active eye or systemic disease, the patient was commenced on quadruple ATT with the aim of reducing the risk of visual loss with the MFC. However, after commencing treatment, MFC reactivation was observed. This settled with the addition of high-dose oral prednisone. The steroid was slowly weaned and ceased with the cessation of ATT. There have been no further episodes of active choroiditis since treatment was ceased. TB is a significant cause of mortality worldwide, and ocular manifestations can cause severe and sight-threatening complications in active and latent TB. The treatment of TB, however, may lead to further complications. We present the case of a visually asymptomatic patient with latent TB, with before and after fundal images, demonstrating the reactivation of the MFC after commencing ATT.