Journal List > J Korean Ophthalmol Soc > v.58(1) > 1010757

Ahn, Cho, Ahn, You, and Jeong: The Clinical Manifestations and Differential Diagnosis of Tuberculosis Serpiginous-like Choroiditis and Serpiginous Choroiditis

Abstract

Purpose

The purpose of this study is to make a distinction between tuberculous serpiginous-like choroiditis and serpiginous choroiditis, and compare their clinical manifestations.

Methods

We retrospectively reviewed thirty eight eyes of twenty-six patients who visited our institution and were diagnosed with serpiginous choroiditis from January 2005 to December 2014. The patients were divided into two groups, tuberculosis serpigi-nous-like choroiditis (Tb-SLC) and classic serpiginous choroiditis (classic SC), and were analyzed based on the treatment re-sponse, previous history of Bacillus Calmette– Guérin (BCG) vaccination, positive results of tuberculin skin test (TST), chest X-ray, anterior and fundus examination, and fluorescein angiography (FAG).

Results

Twenty seven eyes of eighteen patients were serpiginous choroiditis and eleven eyes of eight patients were tuber-culosis serpiginous-like choroiditis. There were no significant differences in age, sex, or previous history of BCG vaccination be-tween the two groups. The positive result of the tuberculin skin test and abnormality in the chest X-ray were shown to be sig-nificantly higher in the Tb-SLC group. Multi-focal lesions involving periphery observed in fundus examination and FAG were sig-nificantly higher in Tb-SLC.

Conclusions

In tuberculosis endemic areas such as Korea, tuberculosis serpiginous-like choroiditis should be considered as a differential diagnosis when the patient is suspicious of serpiginous choroiditis. The understanding of various clinical manifes-tations of tuberculosis serpiginous-like choroiditis may derive accurate diagnosis and treatment, enhancing patient’s prognosis. J Korean Ophthalmol Soc 2017;58(1):50-55

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Table 1.
Demographic characteristics of the patients
Tb-SLC (n = 8) Classic SC (n = 18) p-value
Sex (male:female) 6:2 12:6 0.524*
Age (years) 68.6 ± 11.0 66.3 ± 8.9 0.490
Previous tuberculosis history (n, %) 8 (100) 4 (22) <0.010*
Normal chest X-ray (n, %) 0 (0) 14 (78) <0.010*
BCG vaccination (n, %) 6 (75) 14 (78) 0.622*
TST positive (n, %) 8 (100) 0 (0) <0.010*

Values are presented ad mean ± SD or n (%). SD = standard deviation; Tb-SLC = tuberculous serpiginous-like choroiditis; Classic SC = serpiginous choroiditis; BCG = Bacillus Calmette –Guérin; TST = tuberculin skin test.

* Fisher’s exact test; Mann-Whitney U-test.

Table 2.
Comparison of clinical symptoms and signs between Tb-SLC and Classic SC
Tb-SLC (n = 11) Classic SC (n = 27) p-value*
Decreased visual acuity 7 (64) 18 (67) 1.000
Metamorphosia 3 (27) 7 (26) 0.134
Floater 1 (9) 2 (7) 0.395
Recovered visual acuity 3 (27) 7 (26) 0.615
Continuous with optic disc 2 (18) 22 (82) <0.010
Involvement of macula 5 (45) 20 (74) 0.135
Involvement of periphery 11 (100) 2 (7) <0.010
Multifocal lesions 10 (91) 4 (15) <0.010
Anterior segment inflammation 5 (45) 5 (19) 0.116
Posterior segment inflammation 8 (73) 10 (37 ) 0.074

Values are presented as n (%). Tb-SLC = tuberculous serpiginous-like choroiditis; Classic SC = serpiginous choroiditis.

* Fisher's exact test.

Figure 1.
Indocyanine green angiography (ICGA) and fluorescein angiography (FAG) of the patients. ICGA and FAG of tuber-culosis serpiginous-like choroiditis showing wide spread multifocal lesions (A, B), ICGA and FAG of serpiginous choroiditis show-ing large solitary lesion that extends from the juxta-papillary area (C, D).
jkos-58-50f1.tif
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