Choroidal Granuloma as an Initial Manifestation of Systemic Tuberculosis: A Case Report

Case Report

Austin J Clin Ophthalmol. 2023; 10(2): 1143.

Choroidal Granuloma as an Initial Manifestation of Systemic Tuberculosis: A Case Report

Belidi HE*, Saoiabi Y, Baiz T and Cherkaoui LO

Department of Ophthalmology A, Hospital des spécialités, Rabat, Morocco

*Corresponding author: Belidi HEDepartment of Ophthalmology, Specialty Hospital, Rabat, Morocco

Received: January 23, 2023; Accepted: February 28, 2023; Published: March 07, 2023


Purpose: To describe the presentation and management of presumed ocular tuberculosis, successfully treated with anti-tubercular therapy alone.

Case Report: Presumed tuberculous choroidal granuloma associated with serous retinal detachment healed after initiation of antituberculosis therapy without concomitant corticosteroid therapy.

Conclusion: Although corticosteroids are often used as add-on treatment for ocular tuberculosis, selected patients can be treated with anti-tuberculosis therapy alone with close follow-up.

Keywords: Ocular tuberculosis; Choroidal granuloma; ATT; Tuberculosis


Tuberculosis (TB) is an infectious disease that primarily affects the lungs and rarely the eyes. Ocular tuberculosis (OTB) is a common cause of uveitis in North Africa and can be challenging to definitively diagnose. Frequently, diagnoses of presumed OTB are based on a positive tuberculosis test, exclusion of other causes of uveitis, and careful consideration of the patient's history and fundus examination [1].

The most common presentation of OTB is posterior uveitis. The clinical phenotype of posterior uveitis in OTB includes choroidal nodules, choroidal granulomas, subretinal abscesses, serpiginous-like choroiditis and retinal vasculitis [2].

Choroidal tuberculoma is a rare form of OTB that raises both a diagnostic and therapeutic challenges, especially when it occurs in the absence of other disease manifestations [3].

Case Report

We report a case of a 50-year-old woman, she was seen in the emergency department with a one week history of decreased vision and pain in her left eye. Her medical history was noncontributory. The visual acuity measured by the Snellen chart was limited to 20/1000 in her left eye. The visual acuity in her right eye was 20/20. Ophthalmological examination of the left eye showed: 1+ cells in the vitreous, optic disc edema, an elevated non pigmented mass that measured 3 disc diameters, superior and temporal to the optic disc (Figure 1b), and an exudative retinal detachment (Figure 2). The examination of the left right was normal. Fluoroscein angiography showed an early hypofluorescence of the choroidal lesion with late diffusion (Figure 1d). Chest CT and brain MRI were unremarkable. Orbit MRI showed an irregular left intraocular formation, 6mm thick, in high signal intensity on T1-weighted and low signal on T2, taking the macular and papillary region with infiltration of intra-conical retro septal fat, strongly enhanced after injection of gadolinium (Figure 3). Extensive uveitis laboratory testing was nonreactive or within normal limits. However, Quanti FERON-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. The visual acuity in the left eye was 20/200 after 3 months of treatment, 20/40 after 6 months.