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PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 12  |  Page : 2048-2049

Iridocilary tuberculoma mimicking melanoma


1 Department of Uve, Sankara Nethralaya, Chennai, Tamil Nadu, India
2 Department of Vitreoretina Services, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Submission10-Jul-2019
Date of Acceptance19-Aug-2019
Date of Web Publication22-Nov-2019

Correspondence Address:
Dr. Sridharan Sudharshan
Department of Uveitis Services, Sankara Nethralaya, Chennai - 600 006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1271_19

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Keywords: Iridociliary mass, melanoma, masquerade, ocular tuberculosis, polymerase chain reaction, tuberculoma


How to cite this article:
Latiff N, Sudharshan S, Verma A, Khetan V, Biswas J. Iridocilary tuberculoma mimicking melanoma. Indian J Ophthalmol 2019;67:2048-9

How to cite this URL:
Latiff N, Sudharshan S, Verma A, Khetan V, Biswas J. Iridocilary tuberculoma mimicking melanoma. Indian J Ophthalmol [serial online] 2019 [cited 2019 Dec 10];67:2048-9. Available from: http://www.ijo.in/text.asp?2019/67/12/2048/271354



A 44-year old man presented with painful diminished vision in the right eye since 2 months. Best-corrected visual acuity was 6/9; N8 in the right eye. Slit lamp examination of the right eye revealed an anterior chamber reaction of 2+, mutton fat keratic precipitates with broad-based posterior synechiae. A greyish white mass measuring approximately 8 mm × 3.5 mm at its greatest dimension was noticed along the iris surface extending from 6 to 9 o' clock hours positions into the angles [Figure 1]a and [Figure 1]b. Ultrasound biomicroscopy (UBM) of the right eye revealed an heterogenous iridociliary mass with echolucent spaces within the same quadrant. Posterior segments including the anterior vitreous was normal. Left eye was clinically normal. Laboratory investigation revealed a raised ESR and serum ACE levels, negative Mantoux, normal Chest radiography and bilateral cervical lymphadenopathy. MRI did not rule out melanoma. Polymerase chain reaction (PCR) from aqueous was positive for MPB64 genome. Cytology revealed only inflammatory cells. Patient was treated with full course of ATT and short course of systemic steroids and lesion resolved completely [Figure 2]. At 1-year follow-up, both eyes were quiet and vision was normal with no recurrences.
Figure 1: (a) Diffuse illumination slit lamp picture of the right eye showing the anterior chamber mass with Mutton Fat Keratic precipitates. (b) Gonioscopy showing the lesion extending into the angle

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Figure 2: Post Treatment slit lamp picture of the right eye showing complete resolution of the lesion

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Iris and ciliary body tuberculoma is a rare form of uveal tuberculosis[1],[2],[3] Our patient presented with iridociliary mass extending into the angle with granulomatous reaction. Cervical lymphadenopathy and a negative Mantoux led to a suspicious disseminated disease. Biopsy proven ciliary body tuberculoma, after enucleation, presenting with granulomatous anterior uveitis and positive tuberculin test have been reported.[4] Histopathologic confirmation from ocular tissues is not always possible. Routine investigations including MRI were equivocal in our patient. PCR MTB positivity of aqueous clinched the diagnosis and led to complete resolution of the lesion with ATT.

Our case highlights the importance of ruling out tubercular granuloma even in anterior chamber mass lesions, especially in endemic areas. PCR testing of aqueous by a simple out-patient procedure of an anterior chamber tap can clinch the diagnosis and prevent enucleation of the eye.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rosen PH, Spalton DJ, Graham EM. Intraocular tuberculosis. Eye 1990;4:486.  Back to cited text no. 1
    
2.
Helm CJ, Holland GN. Ocular tuberculosis. Surv Ophthalmol 1993;38:229-56.  Back to cited text no. 2
    
3.
Albert DM, Raven ML. Ocular Tuberculosis. Microbiol Spectr 2016;4(6).  Back to cited text no. 3
    
4.
Ni C, Papale JJ, Robinson NL, Wu BF. Uveal tuberculosis. Int Ophthalmol Clin 1982;22:103-24.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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