Spectral domain optical coherence tomography imaging of tubercular chorioretinitis and intraretinal granuloma. Intraretinal tuberculosis: a case report

Abstract

The aim of this study is to report the clinical and spectral domain optical coherence tomography (SD-OCT) findings in a patient suffering from ulcerative colitis with bilateral tubercular chorioretinitis and intraretinal granuloma regressed with systemic antitubercular therapy (ATT). This study is a case report of a 33-year-old Bangladeshi male with ulcerative colitis treated with oral corticosteroids and azathioprine who was referred to our department with a diagnosis of central serous chorioretinopathy. Serological tests, the Mantoux skin test, complete ophthalmologic examination, ocular fundus photography, fundus fluorescein angiography, and SD-OCT scans were performed. The ophthalmological inflammatory pattern and serological investigations provided an early diagnosis of ocular tuberculosis. Systemic ATT led to significant improvement and resolution of the ocular inflammation. SD-OCT was a useful non-contact imaging technique in the follow-up of tubercular choroiditis. The excellent response to systemic ATT confirmed the clinical diagnosis. This is an unusual case of tubercular chorioretinitis with intraretinal granuloma and is the first such SD-OCT description reported in the ophthalmological literature.

Differences between Mycobacterium chimaera and tuberculosis Using Ocular Multimodal Imaging: A Systematic Review

“…In the case of intraretinal TB granuloma, OCT reveals a rounded, hyperreflective lesion in the neurosensory retina, which comprises a partially hyporeflective core underlying a hyperreflective area with surrounding neurosensory retinal detachment [ 36 ]. The presence of hyperreflective dots in the outer retina are attributed to proliferating RPE.…”

“…The presence of hyperreflective dots in the outer retina are attributed to proliferating RPE. Non-homogenous localized thickening is observed in the RPE/choriocapillaris complex under the retinal lesion devoid of any dome-shaped retinal elevation [ 23 , 36 ].…”

Presumed Intraretinal Tuberculosis: Case Report With Multimodal Imaging Including Optical Coherence Tomography Angiography

“…Our patient had no evidence of systemic tuberculous disease; however, cases of intraocular tuberculosis, including primary retinal tuberculosis specifically, occurring in the absence of concurrent systemic disease are well documented. 1,3,4 Structural OCT has proven useful in the diagnosis and management of ocular tuberculosis. 2,7 For example, structural OCT with enhanced depth imaging has been used to identify characteristic features of tuberculous choroidal granulomas.…”

“…Choroidal granulomas are the most frequent posterior segment manifestation of ocular tuberculosis, whereas primary intraretinal tuberculosis is more rarely reported. 1,3 Pirraglia et al 4 reported a case of an intraretinal tuberculous granuloma and demonstrated the regression of the granuloma by spectral domain OCT after the initiation of ATT. Optical coherence tomography imaging in that case revealed a round intraretinal hyperreflective lesion surrounding a hyporeflective core, which the authors postulated represented abscess surrounded by inflammatory response.…”

Clinical and Epidemiological Study on Tubercular Uveitis in a Tertiary Eye Care Centre in Italy

“…Specifically, results are controversial about the specific anti-TB treatment (ATT) in patients with TBU [6,12]. e most frequent ATT for patients with TBU is the use of four drugs (Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide) for 2 months followed by two drugs, Rifampicin and Isoniazid, for 4 months [13][14][15]. In addition, patients with TBU may develop ocular complications which require specific treatments, such as corticosteroids for cystoid macular edema (CME) or ocular surgery in patients with cataract [16][17][18].…”