Tubercular serpiginous-like choroiditis

Abstract

Choroidal tuberculosis (TB) infection may present itself as a diffuse choroiditis that resembles serpiginous choroiditis, usually treated with immunossupressants. Recent studies have demonstrated that patients with serpiginous-like choroiditis and evidence of systemic or latent TB are best treated with antituberculosis treatment (ATT) in addition to the corticosteroid therapy. The authors present a case of a 58-year-old man with decreased vision in his left eye. His best-corrected visual acuity was 20/20 right eye and 20/200 left eye. Funduscopic examination revealed a diffuse choroiditis. Mantoux skin test showed an area of induration measuring 30×35 mm and the patient started ATT with complete resolution of retinal lesions after 2 weeks of treatment. His final visual acuity was 20/25 in the left eye with no recurrences over a follow-up of 6 months. The use of ATT in these patients is likely to reduce active inflammation and eliminate future recurrences.

Figure 1

Fundus of left eye showing diffuse choroiditis with multifocal, yellowish-white, subretinal lesions.

Figure 2

On fluorescein angiography, the multifocal lesions showed initial hypofluorescence (on the left) with late hyperfluorescence (on the right).

Figure 3

Fundus of left eye after initiating treatment with ATT showing complete resolution of retinal lesions.