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Ocular Tuberculosis: A Case Report
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Maryam Asli   , Mousa Ahmadi , Dariush Robati , Saeed Soleiman-Meigooni  |
| Infectious Diseases Research Center, AJA University of Medical Sciences, Tehran, Iran. |
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Abstract: (12 Views) |
Introduction: Ocular tuberculosis (TB) is a rare but serious extrapulmonary manifestation of Mycobacterium tuberculosis infection, recognized as a "great mimicker" in ophthalmology, capable of involving any ocular structure, including tubercular serpiginous-like choroiditis (TB-SLC), often presenting with minimal anterior inflammation but progressive deep involvement. In this report, we presented a case of ocular tuberculosis with chorioretinal involvement.
Report of the Case: A 49-year-old woman with a history of migraine headaches presented with bilateral blurred vision, mild photophobia, and diplopia for two months. The fundoscopy revealed bilateral optic disc edema, multifocal yellowish-gray chorioretinal lesions, and mild vitritis; fluorescein angiography confirmed active vascular vasculitis, choriocapillaris ischemia, progressive chorioretinitis, and a peripapillary serpiginous-like pattern extending toward the macula; fundus autofluorescence revealed active edges and hyper autofluorescence compatible with inflammation and central hypo autofluorescent areas atrophy, compatible with retinal pigment epithelium (RPE) atrophy. Initial laboratory findings were negative for brucellosis, HSV, CMV, and toxoplasmosis, as well as normal results for rheumatologic biomarkers and angiotensin-converting enzyme inhibitors level; cerebrospinal fluid analysis showed mild hypoglycorrhachia and monocytic pleocytosis, but negative multiplex PCR results (including TB). Her PPD was 20 mm, and the QuantiFERON test result was positive, as well as the normal brain MRI. So, we excluded other infectious and non-infectious etiologies for chorioretinitis, and a diagnosis of probable intraocular TB COTS/BTS classification (Collaborative Ocular Tuberculosis Study) was made. The patient received a 12-month quadruple anti-TB regimen (isoniazid, rifampin, ethambutol, pyrazinamide), oral prednisolone 1 mg/kg for one month, cycloplegic drops, and acetazolamide; improvement began in week 2, symptoms markedly reduced by month 1, and nearly complete resolution by year-end without reported recurrence after one year follow-up.
Conclusion: This case underscores the importance of early TB-SLC diagnosis in endemic areas, even with negative PCR and subtle inflammatory signs, demonstrating that prolonged anti-TB therapy (12 months) combined with systemic corticosteroids can prevent progression to macular scarring and severe vision loss; COTS consensus and BTS guidelines aid management in "probable" cases.
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| Keywords: Ocular Tuberculosis, Tuberculous Chorioretinitis, CNS Tuberculosis |
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Full-Text [PDF 539 kb]
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Type of Study: case report |
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Received: 2026/02/23 | Accepted: 2025/06/22 | Published: 2025/06/22
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