Published date: Dec 31 2024

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: Oct–Dec 2024, Volume 19, Issue 4

Pages: 512 – 518

DOI: 10.18502/jovr.v19i4.11199

Masoud Soheilianmasoud_soheilian@yahoo.comOcular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Pejvak Azadiazadipe@yahoo.comDepartment of Ophthalmology, Emam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran

Purpose: To report a case of tubercular choroiditis that was initially treated for multifocal choroiditis. Case
Report: A 54-year-old female patient diagnosed with multifocal choroiditis was referred to the clinic while undergoing treatment with systemic prednisone and methotrexate. The presenting visual acuity was 20/100 in the right eye and finger counting at 1 meter in the left eye. Further investigation by repeated tuberculin skin test and QuantiFERON-TB Gold test revealed tuberculosis as the probable cause of choroiditis. The patient was started on a four-drug antituberculosis regimen. Six months later, the vision improved significantly to 20/30 in the right eye and finger counting at 6 meters in the left eye, with no remaining cellular reaction.
Conclusion: Tuberculosis should be considered in the differential diagnosis of multifocal choroiditis, and it is vital to perform careful history taking and thorough examinations.

Keywords: Multifocal Choroiditis, Ocular Tuberculosis, Uveitis

1. World health organization. Global Tuberculosis Report 2022 Factsheet. https://www.who.int/publications/m/item/ global-tuberculosis-report-2022-factsheet

2. Gunasekeran DV, Gupta B, Cardoso J, Pavesio CE, Agrawal R. Visual morbidity and ocular complications in presumed intraocular tuberculosis: An analysis of 354 cases from a non-endemic population. Ocul Immunol Inflamm 2018;26:865–869.

3. Gupta V, Gupta A, Rao NA. Intraocular tuberculosis—An update. Surv Ophthalmol 2007;52:561–587.

4. Agrawal R, Gunasekeran DV, Raje D, Agarwal A, Nguyen QD, Kon OM, et al.; Collaborative Ocular Tuberculosis Study Group. Global variations and challenges with tubercular uveitis in the collaborative ocular tuberculosis study. Invest Ophthalmol Vis Sci 2018;59:4162–4171.

5. El-Asrar AM, Herbort CP, Tabbara KF. A clinical approach to the diagnosis of retinal vasculitis. Int Ophthalmol 2010;30:149–173.

6. Agrawal R, Gunasekeran DV, Agarwal A, Carreño E, Aggarwal K, Gupta B, et al. The Collaborative Ocular Tuberculosis Study (COTS)-1: A multinational description of the spectrum of choroidal involvement in 245 patients with tubercular uveitis. Ocul Immunol Inflamm 2020;28:38–48.

7. Agrawal R, Agarwal A, Jabs DA, Kee A, Testi I, Mahajan S, et.al. Collaborative Ocular Tuberculosis Study (COTS) Group. Standardization of nomenclature for ocular tuberculosis - Results of Collaborative Ocular Tuberculosis Study (COTS) workshop. Ocul Immunol Inflamm 2020;28:74–84.

8. Gunasekeran DV, Agrawal R, Agarwal A, Carreño E, Raje D, Aggarwal K, et al.; COTS-1 Study Group. The Collaborative Ocular Tuberculosis Study (COTS)-1: A multinational review of 251 patients with tubercular retinal vasculitis. Retina 2019;39:1623–1630.

9. Agrawal R, Gunasekeran DV, Grant R, Agarwal A, Kon OM, Nguyen QD, et al.; Collaborative Ocular Tuberculosis Study (COTS)–1 Study Group. Clinical features and outcomes of patients with tubercular uveitis treated with antitubercular therapy in the Collaborative Ocular Tuberculosis Study (COTS)-1. JAMA Ophthalmol 2017;135:1318–1327.

10. Gupta V, Shoughy SS, Mahajan S, Khairallah M, Rosenbaum JT, Curi A, et al. Clinics of ocular tuberculosis. Ocul Immunol Inflamm 2015;23:14–24.

11. Kee AR, Gonzalez-Lopez JJ, Al-Hity A, Gupta B, Lee CS, Gunasekeran DV, et al. Anti-tubercular therapy for intraocular tuberculosis: A systematic review and metaanalysis. Surv Ophthalmol 2016;61:628–653.

12. https://www.cdc.gov/tb/publications/factsheets/testing/ skintesting.htm

13. Manuel O, Kumar D. QuantiFERON-TB Gold assay for the diagnosis of latent tuberculosis infection. Expert Rev Mol Diagn 2008;8:247–256.

14. Abu El-Asrar AM, Herbort CP, Tabbara KF. Differential diagnosis of retinal vasculitis. Middle East Afr J Ophthalmol 2009;16:202–218.

15. Ebrahimiadib N, Maleki A, Fadakar K, Manhapra A, Ghassemi F, Foster CS. Vascular abnormalities in uveitis. Surv Ophthalmol 2021;66:653–667.

16. Al-Dhibi H, Hamade IH, Al-Halafi A, Barry M, Chacra CB, Gupta V, et al. The effects of intravitreal bevacizumab in infectious and noninfectious uveitic macular edema. J Ophthalmol 2014;2014:729465.

17. Taguchi M, Sakurai Y, Kanda T, Takeuchi M. Anti-VEGF therapy for central retinal vein occlusion caused by tuberculosis-associated uveitis: A case report. Int Med Case Rep J 2017;10:139–141.

18. Oray M, Onal S, Uludag G, Akbay AK, Tugal-Tutkun I. Interferon Alpha for the Treatment of Cystoid Macular Edema Associated with Presumed Ocular Tuberculosis. J Ocul Pharmacol Ther 2017;33:304–312.

19. Invernizzi A, Iannaccone F, Marchi S, Mastrofilippo V, Coassin M, Fontana L, et al. Interferon Alpha-2a for the treatment of post-infectious uveitis secondary to presumed intraocular tuberculosis. Ocul Immunol Inflamm 2019;27:643–650.

20. Torres RM, Calonge M. Macular edema as the only ocular finding of tuberculosis. Am J Ophthalmol 2004;138:1048–1049.