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  • Grand Rounds

    A patient with a past ocular history of cataract extraction and YAG capsulotomy presented with chronic blurry vision, photopsia, and floaters in both eyes of 1 year duration. He had been prescribed topical steroids for cystoid macular edema in the left eye after recent YAG capsulotomy. His history was notable for multiple trips to southeast Asian to visit family. His visual acuity was 20/20 in the right eye and 20/25 in the left eye with intraocular pressure of 13 mm Hg in the right eye and 24 mm Hg in the left eye. Slit lamp exam showed normal anterior segments with focal vitreous opacities in both eyes and trace vitreous haze and 1+ vitreous cell in the left eye. There was multifocal subretinal chorioretinal scarring extending from the nerve but sparing the fovea in the left eye and a few small scattered peripheral foci of chorioretinal scarring in the right eye. Multimodal imaging showed outer retinal loss and retinal pigment epithelium atrophy and irregularity in the area of the subretinal scarring with early blockage and late staining on fluorescein angiography, hypocyanescence on indocyanine green angiography, and mixed hypo- and hyper-autofluorescence of the lesions. Systemic workup yielded a positive PPD and T-spot test, consistent with a diagnosis of tuberculous serpiginous-like choroiditis. The patient was started on 4-drug anti-tuberculous therapy (ATT) for active extrapulmonary tuberculosis with later addition of systemic steroids for paradoxical inflammatory reaction. The subretinal lesions become progressively atrophic on exam and imaging with completion of 9 months ATT with final vision of 20/40 in the right eye and 20/100 in the left eye.

    Presentation Date: 11/04/2021
    Issue Date: 11/12/2021