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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.


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Complete resolution of the lesion after ATT and oral steroids.
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Fig9: Complete resolution of the lesion after ATT and oral steroids.

Mentions: An anterior chamber tap was performed and the aqueous humor was analyzed by staining for acid-fast bacilli, by polymerase chain reaction (PCR), and by real-time polymerase chain reaction (RT-PCR) kit to detect Mycobacterium tuberculosis (MTB) complex genome. DNA extraction from the aqueous humor was carried out using QIAMP DNA extraction kit (Qiagen, Venlo, the Netherlands) and RT-PCR for MTB was carried out using Genosen's MTB complex quantitative real-time PCR kit (Genome Diagnostics, Parwanoo, India). Aqueous humor analysis revealed the absence of acid-fast bacilli, and both PCR and RT-PCR were negative for tuberculosis genome. On the basis of clinical, angiographic, and radiological evidence, multiple healed choroidal tuberculomas in the right eye and active military choroidal tuberculoma in the left eye were diagnosed. Management with anti-tubercular treatment in the form of four drugs with isoniazid, ethambutol, pyrazinamide, and rifampicin for 3 months and isoniazid and rifampicin for 6 months was done. This was supplemented with prednisolone tablet 30 mg a day for 1 week tapered to 5 mg weekly to help resolve the surrounding choroidal inflammation along with ranitidine tablet and oral calcium supplements. On review after 3 months, the patient showed an improvement in her best corrected visual acuity to 6/6 and N6 in the left eye. On examination, the choroidal tuberculoma was found to have completely resolved, the ocular status was stable, and the only evidence of the lesion was pigmentation (Figure 9).Figure 9


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

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

Complete resolution of the lesion after ATT and oral steroids.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig9: Complete resolution of the lesion after ATT and oral steroids.
Mentions: An anterior chamber tap was performed and the aqueous humor was analyzed by staining for acid-fast bacilli, by polymerase chain reaction (PCR), and by real-time polymerase chain reaction (RT-PCR) kit to detect Mycobacterium tuberculosis (MTB) complex genome. DNA extraction from the aqueous humor was carried out using QIAMP DNA extraction kit (Qiagen, Venlo, the Netherlands) and RT-PCR for MTB was carried out using Genosen's MTB complex quantitative real-time PCR kit (Genome Diagnostics, Parwanoo, India). Aqueous humor analysis revealed the absence of acid-fast bacilli, and both PCR and RT-PCR were negative for tuberculosis genome. On the basis of clinical, angiographic, and radiological evidence, multiple healed choroidal tuberculomas in the right eye and active military choroidal tuberculoma in the left eye were diagnosed. Management with anti-tubercular treatment in the form of four drugs with isoniazid, ethambutol, pyrazinamide, and rifampicin for 3 months and isoniazid and rifampicin for 6 months was done. This was supplemented with prednisolone tablet 30 mg a day for 1 week tapered to 5 mg weekly to help resolve the surrounding choroidal inflammation along with ranitidine tablet and oral calcium supplements. On review after 3 months, the patient showed an improvement in her best corrected visual acuity to 6/6 and N6 in the left eye. On examination, the choroidal tuberculoma was found to have completely resolved, the ocular status was stable, and the only evidence of the lesion was pigmentation (Figure 9).Figure 9

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