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Ocular Tuberculoma in the Absence of Miliary TB

Background: While tuberculosis is a common disease worldwide, the incidence of tuberculomas in the eye is rare in developed nations. Posterior segment tuberculomas typically present with associated uveitis, although, among patients with uveitis, a diagnosis of tuberculosis infection is less than 0.1%. The most commonly affected ocular structure is the choroid, and as such, tuberculomas can share many characteristics with choroidal tumors. Given it’s the varied nature of presentation, clinical diagnosis is challenging.

Methods and findings: A retrospective case report of a 45- year-old Filipino woman presented with blurred vision in her right eye two years after immigrating to the United States. The right eye demonstrated an amelanotic choroidal lesion in the macula of the right eye, mimicking an amelanotic choroidal melanoma or choroidal metastasis. A positive Tuberculin Skin Test and IGRA allowed for anti-mycobacterial therapy to be initiated. On follow up, the subretinal fluid and visual symptoms resolved.

Conclusions: Tubercular eye granulomas require a high degree of suspicion as they can mimic choroidal tumors. This case report demonstrates how careful anti-tubercular therapy can lead to excellent lesion regression once properly identified.


Caleb R. Walker, Haroon N. Khan, Eric W. Schneider, David A. Reichstein

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