Choroidal tuberculoma: malignancy or infection

Abstract

ABSTRACT Choroidal tuberculoma is a rare form of ocular tuberculosis that poses a diagnostic dilemma when there is no systemic manifestation. We describe a case of a 37-year-old lady who presented with decreased vision and superior visual field defect in her right eye for a duration of 2 weeks. The right eye visual field defect was described as a superior altitudinal field defect. Her visual acuity in the right eye was 20/30. Right fundus examination revealed an elevated hypopigmented subretinal mass measuring 7-disc diameter at the inferotemporal arcade with the presence of surrounding subretinal fluid and pigmentary changes. B-scan showed choroidal excavation with low internal reflectivity. Based on a positive QuantiFERON-TB immunoassay and clinical correlation, a diagnosis of presumed ocular tuberculosis was made. She responded to a 9-month course of anti-TB treatment, and the lesion gradually decreased in size. This case highlights the importance of QuantiFERON-TB immunoassay in aiding the diagnosis of presumed ocular tuberculosis without any systemic manifestations of tuberculosis.

Keywords

• Tuberculome
• Tuberculosis, ocular
• Tuberculosis
• Subretinal fluid
• Visual fields
• Choroid
• Visual acuity