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Bilateral choroidal tuberculoma in miliary tuberculosis - report of a case.

Annamalai R, Biswas J - J Ophthalmic Inflamm Infect (2015)

Bottom Line: Tubercles can arise in the early stages of progression of TB and indicate hematogenous dissemination before the development of symptomatic disease.The patient was an immunocompetent girl with splenic and miliary TB and had a relatively asymptomatic systemic status.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.

View Article: PubMed Central - PubMed

Affiliation: Sri Ramachandra University, Porur, Chennai, 600166 India.

ABSTRACT

Background: A 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.

Findings: We 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.

Conclusions: This 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.

No MeSH data available.


Related in: MedlinePlus

Early arteriovenous phase of fluorescein angiogram showing diffuse hyperfluorescence due to subretinal leakage of dye in the left eye.
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Fig4: Early arteriovenous phase of fluorescein angiogram showing diffuse hyperfluorescence due to subretinal leakage of dye in the left eye.

Mentions: A 13-year-old girl presented with complaints of diminution of vision in her left eye for 3 weeks. On examination, her best corrected visual acuity for distance and near was 6/6 with N6 in her right eye and 6/24 and N6 with effort in her left eye, respectively. Slit lamp examination of the anterior segment and intraocular pressure were normal. Vitreous was normal with no cells or haze. Dilated fundus examination of the right eye revealed multiple, well-defined, yellow subretinal, healed choroidal tuberculomas (Figure 1). The left eye showed a single ill-defined, yellow subretinal lesion with dimensions of 20 × 16 mm located along the superotemporal arcade with surrounding edema and exudative retinal detachment. FFA showed diffuse hyperfluorescence in the early phase (Figures 2 and 3) and pooling of dye in the late phase (Figure 4). ICG showed hypocyanescent lesions that corresponded to the choroidal tuberculomas (Figures 5, 6, and 7). OCT in the left eye showed serous detachment of the neurosensory retina involving the macular area (Figure 8). Systemic evaluation with high-resolution CT showed few small calcified mediastinal lymph nodes and evidence of splenic tuberculosis.Figure 1


Bilateral choroidal tuberculoma in miliary tuberculosis - report of a case.

Annamalai R, Biswas J - J Ophthalmic Inflamm Infect (2015)

Early arteriovenous phase of fluorescein angiogram showing diffuse hyperfluorescence due to subretinal leakage of dye in the left eye.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384973&req=5

Fig4: Early arteriovenous phase of fluorescein angiogram showing diffuse hyperfluorescence due to subretinal leakage of dye in the left eye.
Mentions: A 13-year-old girl presented with complaints of diminution of vision in her left eye for 3 weeks. On examination, her best corrected visual acuity for distance and near was 6/6 with N6 in her right eye and 6/24 and N6 with effort in her left eye, respectively. Slit lamp examination of the anterior segment and intraocular pressure were normal. Vitreous was normal with no cells or haze. Dilated fundus examination of the right eye revealed multiple, well-defined, yellow subretinal, healed choroidal tuberculomas (Figure 1). The left eye showed a single ill-defined, yellow subretinal lesion with dimensions of 20 × 16 mm located along the superotemporal arcade with surrounding edema and exudative retinal detachment. FFA showed diffuse hyperfluorescence in the early phase (Figures 2 and 3) and pooling of dye in the late phase (Figure 4). ICG showed hypocyanescent lesions that corresponded to the choroidal tuberculomas (Figures 5, 6, and 7). OCT in the left eye showed serous detachment of the neurosensory retina involving the macular area (Figure 8). Systemic evaluation with high-resolution CT showed few small calcified mediastinal lymph nodes and evidence of splenic tuberculosis.Figure 1

Bottom Line: Tubercles can arise in the early stages of progression of TB and indicate hematogenous dissemination before the development of symptomatic disease.The patient was an immunocompetent girl with splenic and miliary TB and had a relatively asymptomatic systemic status.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.

View Article: PubMed Central - PubMed

Affiliation: Sri Ramachandra University, Porur, Chennai, 600166 India.

ABSTRACT

Background: A 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.

Findings: We 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.

Conclusions: This 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.

No MeSH data available.


Related in: MedlinePlus