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Serpiginous-like choroiditis as sign of intraocular tuberculosis.

Znaor L, Medic A, Karaman K, Perkovic D - Med. Sci. Monit. (2011)

Bottom Line: The patient presented with gradual painless loss of central vision in his left eye and dark rings in the central visual field of the right eye.Upon examination, he was found to have 1 round choroidal lesion centered in the left macula and multiple serpiginous-like choroidal lesions in the right eye.An immunosuppressive agent (Azathioprine) was consequently administered due to unsatisfactory response to initial therapy and the vicinity of the pathological process to the right fovea.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University Hospital Centre, University of Split School of Medicine, Split, Croatia. ljuboznaor@gmail.com

ABSTRACT

Background: Tuberculosis is a world-wide public health problem which may clinically present in many different ways. Here we report on a patient with presumed serpiginous choroiditis (PSC) found to have latent ocular tuberculosis.

Case report: The clinical history and physical examination, complete blood count, erythrocyte sedimentation rate, chest radiograph, fundus fluorescein angiography, tuberculin skin test, serological tests, and systemic evaluation carried out by consultant internist of a 42-year-old man with PSC were evaluated. The patient presented with gradual painless loss of central vision in his left eye and dark rings in the central visual field of the right eye. Upon examination, he was found to have 1 round choroidal lesion centered in the left macula and multiple serpiginous-like choroidal lesions in the right eye. Based on positive tuberculin skin test result, the patient was initially treated with anti-tubercular therapy combined with systemic corticosteroids. An immunosuppressive agent (Azathioprine) was consequently administered due to unsatisfactory response to initial therapy and the vicinity of the pathological process to the right fovea.

Conclusions: It is important to remember that tubercular choroiditis may present with clinical features of serpiginous choroiditis, requiring timely and appropriate therapy and close observation in order to prevent the progression of visual loss and recurrences.

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Related in: MedlinePlus

(A, B) Red free fundus photographs of round subretinal, grayish-yellow lesions in temporal macula and nasal parapapillary region of the right eye (ampiginous form of serpiginous coroiditis) and foveal solitary lesion of the left eye (macular form of serpiginous coroiditis). There is also a peripapillary geographic subretinal yellowish lesion present in the right eye. (C, D) Fluorescein angiography, showing early hypofluorescence, (E, F) followed by late leakage in the active areas of both eyes.
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f1-medscimonit-17-7-cs88: (A, B) Red free fundus photographs of round subretinal, grayish-yellow lesions in temporal macula and nasal parapapillary region of the right eye (ampiginous form of serpiginous coroiditis) and foveal solitary lesion of the left eye (macular form of serpiginous coroiditis). There is also a peripapillary geographic subretinal yellowish lesion present in the right eye. (C, D) Fluorescein angiography, showing early hypofluorescence, (E, F) followed by late leakage in the active areas of both eyes.

Mentions: A 42-year-old man complained of deterioration in left eye (LE) visual acuity (VA) and dark rings in the central visual field of the right eye (RE) for 2 days. The patient smoked 40 cigarettes daily. LE and RE VA was 1.0 and <0.1, respectively (Snellen charts). The anterior chambers and vitreous bodies were quiet. A fundus examination revealed bilateral, multiple, round, subretinal, grayish-yellow lesions, and a peripapillary geographic yellowish lesion in the RE. All lesions had sustained activity by fluorescein angiography (FA) (Figure 1).


Serpiginous-like choroiditis as sign of intraocular tuberculosis.

Znaor L, Medic A, Karaman K, Perkovic D - Med. Sci. Monit. (2011)

(A, B) Red free fundus photographs of round subretinal, grayish-yellow lesions in temporal macula and nasal parapapillary region of the right eye (ampiginous form of serpiginous coroiditis) and foveal solitary lesion of the left eye (macular form of serpiginous coroiditis). There is also a peripapillary geographic subretinal yellowish lesion present in the right eye. (C, D) Fluorescein angiography, showing early hypofluorescence, (E, F) followed by late leakage in the active areas of both eyes.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539566&req=5

f1-medscimonit-17-7-cs88: (A, B) Red free fundus photographs of round subretinal, grayish-yellow lesions in temporal macula and nasal parapapillary region of the right eye (ampiginous form of serpiginous coroiditis) and foveal solitary lesion of the left eye (macular form of serpiginous coroiditis). There is also a peripapillary geographic subretinal yellowish lesion present in the right eye. (C, D) Fluorescein angiography, showing early hypofluorescence, (E, F) followed by late leakage in the active areas of both eyes.
Mentions: A 42-year-old man complained of deterioration in left eye (LE) visual acuity (VA) and dark rings in the central visual field of the right eye (RE) for 2 days. The patient smoked 40 cigarettes daily. LE and RE VA was 1.0 and <0.1, respectively (Snellen charts). The anterior chambers and vitreous bodies were quiet. A fundus examination revealed bilateral, multiple, round, subretinal, grayish-yellow lesions, and a peripapillary geographic yellowish lesion in the RE. All lesions had sustained activity by fluorescein angiography (FA) (Figure 1).

Bottom Line: The patient presented with gradual painless loss of central vision in his left eye and dark rings in the central visual field of the right eye.Upon examination, he was found to have 1 round choroidal lesion centered in the left macula and multiple serpiginous-like choroidal lesions in the right eye.An immunosuppressive agent (Azathioprine) was consequently administered due to unsatisfactory response to initial therapy and the vicinity of the pathological process to the right fovea.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University Hospital Centre, University of Split School of Medicine, Split, Croatia. ljuboznaor@gmail.com

ABSTRACT

Background: Tuberculosis is a world-wide public health problem which may clinically present in many different ways. Here we report on a patient with presumed serpiginous choroiditis (PSC) found to have latent ocular tuberculosis.

Case report: The clinical history and physical examination, complete blood count, erythrocyte sedimentation rate, chest radiograph, fundus fluorescein angiography, tuberculin skin test, serological tests, and systemic evaluation carried out by consultant internist of a 42-year-old man with PSC were evaluated. The patient presented with gradual painless loss of central vision in his left eye and dark rings in the central visual field of the right eye. Upon examination, he was found to have 1 round choroidal lesion centered in the left macula and multiple serpiginous-like choroidal lesions in the right eye. Based on positive tuberculin skin test result, the patient was initially treated with anti-tubercular therapy combined with systemic corticosteroids. An immunosuppressive agent (Azathioprine) was consequently administered due to unsatisfactory response to initial therapy and the vicinity of the pathological process to the right fovea.

Conclusions: It is important to remember that tubercular choroiditis may present with clinical features of serpiginous choroiditis, requiring timely and appropriate therapy and close observation in order to prevent the progression of visual loss and recurrences.

Show MeSH
Related in: MedlinePlus