Choroidal Granuloma from Presumed Ocular Tuberculosis

An adult patient presented to the Bascom Palmer emergency room with 1 year of vision loss in the right eye and 3 months of vision loss in the left eye. She lived outside the United States in a country where tuberculosis was non-endemic, however worked on a cruise ship for several years. She had a history of idiopathic panuveitis in the right eye treated with multiple rounds of oral steroid. She also had a history of latent tuberculosis treated 6 years ago with a 6-month course of isoniazid. Her visual acuity was 20/400 in the right eye and 20/100 in the left. Slit lamp examination revealed bilateral anterior chamber and vitreous cells. Fundus examination revealed extensive macular scarring in the right eye and a choroidal granuloma with an exudative retinal detachment of the left eye. She had a chest x-ray, brain MRI, ACE and syphilis testing performed at an outside hospital that were all normal. She also had a QuantiFERON-TB test that returned positive. The patient was started on oral steroids with resolution of the choroidal granuloma and exudative retinal detachment, and her vision improved to 20/40 in the left eye. The patient was referred to her infectious disease doctor to initiate anti-tubercular therapy for presumptive ocular TB.

Presentation Date: 01/25/2024

Issue Date: 02/02/2024