Answer to the last #DiagnosticDilemma
Correct Answer: Tuberculous choroiditis

Clinical Pearls:-

Choroidal involvement in intraocular tuberculosis can have 3 distinct presentations in decreasing order of frequency: choroidal tuberculoma, multifocal choroiditis, and serpiginous-like choroiditis.

Ophthalmoscopically, choroid tubercles appear as small, round, subretinal, noninflamed, pale yellow spots usually located near the optic disc and represent caseating granulomas in the highly vascular choroid with surrounding stromal swelling and infiltration with round cells, epithelioid, and giant cells.

Their presence signifies systemic focus of tuberculous infection in up to 80% of the cases; the OR for the presence of systemic tuberculosis when choroid tubercles are present is 5.6.

These may be missed even on repeated ophthalmic examination, and large solitary lesions may be confused with an intraocular tumor. Untreated cases may result in retinal detachment and acute loss of vision. Treatment with appropriate antituberculous therapy results in healing with peripheral pigmentation and scarring.

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