Bilateral choroidal tuberculoma

Ocular tuberculosis (TB) has protean manifestations.[1,2] Posterior uveitis is the most common ocular presentation in TB.[3-5] We present a case of bilateral choroidal tuberculoma in a young female. Case A 25-year-old woman presented with dimness of vision in both eyes for the past 2 months. She had a history of shortness of breath, chronic cough, and weight loss for 6 months. On examination, her best corrected visual acuity was 6/36; N36 in the right eye, and her vision was hand movement close to face in the left eye. Slit-lamp examination revealed normal findings in the right eye, and the left eye showed anterior chamber flare (+) and cells (+) with a few granulomatous keratic precipitates. Vitreous cells (++) were present in both eyes. Dilated fundus examination of both eyes showed active choroidal lesions with adjoining pigmented healed scars [Fig. 1]. The Mantoux skin test was very significant, with an induration of 20 mm × 21 mm. The interferon-gamma release assay was also positive. A chest X-ray posterior-anterior view revealed a calcified lesion in the left mid-lung field suggestive of old pulmonary TB. Other investigations were negative. She was started on a 4-drug regimen of anti-tubercular treatment (Isonizid, Rifampicin, Pyrazinamide, and Ethambutol) and oral steroids. The patient was under close follow-up, and the lesion decreased in both eyes by 6 weeks [Fig. 2]. The final visual acuity at the end of 9 months was 6/6P, N6P in OU.Figure 1: Fundus picture showing bilateral choroidal tuberculoma (white arrows) with adjoining old, pigmented scars (black arrows). Macular star formation and surface hemorrhage were seen in the tuberculoma of the left eye (b). The left eye fundus lesion (b) was larger than the right eye (a)Figure 2: Showing a follow up fundus picture of right and left eye (a and b) with resolution of lesions (white arrows)Discussion Choroidal tuberculoma can affect the posterior pole of the fundus.[1-4] Bilateral choroidal involvement can be seen as the choroid has a rich vascular supply, and the TB bacilli from the lungs can spread to the choroid by hematogenous route.[2-5] Prompt diagnosis and appropriate treatment led to effective resolution of the tuberculomas with good visual recovery. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.