Choroidal granuloma resolution with tuberculosis treatment
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
A 31-year-old woman was referred from an outside ophthalmologist with 2 weeks of vision loss in her right eye. Medical history was noncontributory and ocular history was significant for myopia and dry eye. The vision was 20/160 in the right and 20/100 in the left eye with intraocular pressures of 20 and 21 mmHg, respectively. There were 1+ cells and trace cells in the vitreous of the right and left eyes, respectively. Examination of the right eye revealed optic disc edema, an elevated choroidal lesion superior to the macula, and an exudative retinal detachment. Left eye examination revealed several subtle yellow choroidal lesions in the posterior pole.

Chest CT and brain MRI performed at the referring institution were unremarkable. Extensive uveitis laboratory testing (Lyme antibody, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rapid plasma reagin (RPR), syphilis IgG, human immunodeficiency virus (HIV), serum angiotensin-converting enzyme (ACE), lysozyme, anti-nuclear antibody (ANA), anti-double-stranded DNA antibody (anti-dsDNA), anti-extractable nuclear antibodies panel (anti-ENA), rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP)) were nonreactive or within normal limits. However, QuantiFERON-TB Gold test was positive. A diagnosis of presumed ocular TB was made, and she started a 6-month course of rifampin, isoniazid, pyrazinamide, ethambutol and Vitamin B6. 7 weeks later, on anti-tubercular therapy and without any type of corticosteroid treatment, the patient's vision improved to 20/32 (right eye) and 20/40 (left eye), and the choroidal granuloma in the right eye became atrophic. By 10 weeks, the right eye choroidal granuloma resolved on OCT.