Atypical presentation of Tuberculous Choroidopathy

Hemalatha Chandrakanthan

Purpose : To identify atypical presentations of ocular tuberculosis

Method : Case Report
A 44 year old Indian male presented with sudden painless progressive blurring of vision of the left eye for a 1 week duration preceded by a long standing decrease vision of the Right eye. He was otherwise well with no other significant medical history. On examination his visual acuity was 5/60 on his right eye and 6/36 on his left eye. Anterior segment of both eyes were normal. Fundus examination of both eyes revealed a yellowish lesion located at the level of the RPE which had a serpentine like pattern extending from the optic disc to the macula. After clinical evaluation, a fundus fluorescein angiography done revealed hypofluorescence during early dye transit and hyperfluorescence in the late phase. Blood investigations, chest x-ray and tuberculosis work up was done.

Results : A diagnosis of serpinginious choidopathy secondary to tuberculosis was made based on clinical manifestation and investigations that revealed a positive Mantoux Tubeculin skin test. Other results were normal.

Conclusion: Serpiginious Choroidopathy is a rare disease and the cause is usually unknown although it is believed to be an inflammatory disease with immunologic component. The presentation in this case could be misleading since it is not a typical finding of tuberculous choroidopathy which usually appear as granuloma. Although Serpiginous Choroidopathy is a rare presentation in tuberculosis, appropriate investigations and work up has to be conducted as tuberculosis is still a common deadly infectious disease in Asia.