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Abstract
Purpose
To report a case of rapidly progressing foveal atrophy with tuberculous serpiginous-like choroiditis.
Case summary
A 54-year-old female patient had decreased vision of hand motions (os) for 3 days. Fundus examination showed optic disc swelling and yellowish chorioretinal lesions in the posterior pole (os). Optical coherence tomography (OCT) showed intraretinal edema and subretinal fluid in the left macula. Routine laboratory tests, serologic tests, and mag-netic resonance imaging results were normal except for erythrocyte sedimentation rate (28 mm/hr). Fluorescein angiog-raphy showed the chorioretinal lesions appeared to be early hypofluorescence followed by late hyperfluorescence. Indocyanine green angiography showed hypofluorescence during early and late phases and the result of interferon-gamma release assay was positive. Under diagnosis of tuberculous serpiginous-like choroiditis, anti-tuberculous therapy com-bined with systemic corticosteroid was started. Despite decreased optic disc swelling, OCT showed a rapid progression of foveal atrophy within 2 weeks. Twelve weeks later, visual acuity was finger count at 10 cm. Six months later, best-cor-rected visual acuity and foveal atrophy were no interval change.
References
1. Tabbara KF. Tuberculosis. Curr Opin Ophthalmol. 2007; 18:493–501.
2. Sheu SJ, Shyu JS, Chen LM. . Ocular manifestations of tuberculosis. Ophthalmology. 2001; 108:1580–5.
3. Gupta A, Bansal R, Gupta V. . Ocular signs predictive of tu-bercular uveitis. Am J Ophthalmol. 2010; 149:562–70.
4. Sarvananthan N, Wiselka M, Bibby K. Intraocular tuberculosis without detectable systemic infection. Arch Ophthalmol. 1998; 116:1386–8.
5. Hong JW, Park YC, Choi GJ. A case of tuberculous neuroretinitis. J Korean Opthalmol Soc. 2005; 46:1582–5.
6. Song JS, Lee TW. Ocular manifestations of systemic tuberculosis report of 3 cases. J Korean Opthalmol Soc. 1996; 37:1561–9.
8. Gupta V, Gupta A, Arora S. . Presumed tubercular serpiginous like choroiditis: clinical presentations and management. Opthalmology. 2003; 110:1744–9.
9. Vasconcelos-Santos DV, Rao PK, Davies JB. . Clinical features of tuberculous serpiginouslike choroiditis in contrast to classic ser-piginous choroiditis. Arch Ophthalmol. 2010; 128:853–8.
10. Bansal R, Gupta A, Gupta V. . Tubercular serpiginous-like choroi-ditis presenting as multifocal serpiginoid choroiditis. Ophthalmology. 2012; 119:2334–42.
11. Mackensen F, Becker MD, Wiehler U. . QuantiFERON TB- Gold–a new test strengthening long suspected tuberculous in-volvement in serpiginous-like choroiditis. Am J Ophthalmol. 2008; 146:761–6.
12. Kang YA, Lee HW, Yoon HI. . Discrepancy between the tuber-culin skin test and the whole blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuber-culosis-burden country. JAMA. 2005; 293:2756–61.
13. Suzuki J, Oh-I K, Kezuka T. . Comparison of patients with ocu-lar tuberculosis in the1990s and the 2000s. Jpn J Ophthalmol. 2010; 54:19–23.
14. Gupta V, Gupta A, Sachdeva N. . Successful management of tubercular subretinal granulomas. Ocul Immunol Inflamm. 2006; 14:35–40.
15. Gupta V, Bansal R, Gupta A. Continuous progression of tubercular serpiginous-like choroiditis after initiating antituberculosis treatment. Am J Ophthalmol. 2011; 152:857–63.e2.
Figure 1.
(A) Fundus photograph at the initial visit shows severe optic disc swelling and multiple yellowish chorioretinal lesions. The black arrow indicates optical coherence tomography (OCT) scanning line. (B) OCT shows macular edema and subretinal fluid in the left eye (central subfield thickness: 820 μ m). (C, D) Fluorescence angiography of the left eye. Hypofluorescence in the early phase. (C) hyperfluorescence in the late phase (D) are shown at the initial visit. (E, F) Indocyanine green angiography shows hypofluorescence during the early (E) and late phases (F) at the initial visit.
Figure 2.
(A) High-resolution chest computerized tomography shows small clustered micronodules in the left lung apex (black arrow). (B) Two weeks later, fundus photograph shows deceased optic disc swelling and diffuse choroiditis with amoeboid pattern in the posterior pole. The black arrow indicates optical coherence tomography (OCT) scanning line. (C) Fluorescence angiography shows hypofluorescence in the lesions and hyperfluorescence in the borders of lesions. (D) OCT shows an irregularly elevated retinal pigment epithelium line and fovea atrophy (central subfield thickness: 169 μ m).
Figure 3.
(A) Twelve weeks later, fundus photograph shows chorioretinal atrophy with pigmentation in the macula. The black arrow indicates OCT scanning line. (B) Twelve weeks later, OCT shows an irregularly elevated retinal pigment epi-thelium line and fovea atrophy (central subfield thickness: 162 μ m).
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