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PHOTO ESSAY
Year : 2020  |  Volume : 68  |  Issue : 9  |  Page : 1943-1944

Choroidal granuloma in one eye and scleral granuloma in the other in a case of tuberculosis


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India

Date of Submission18-Dec-2019
Date of Acceptance14-Apr-2020
Date of Web Publication20-Aug-2020

Correspondence Address:
Dr. Rohan Chawla
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2328_19

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  Abstract 


Keywords: Choroidal granuloma, disseminated tuberculosis, scleral granuloma


How to cite this article:
Balakrishnan J, Sachan A, Chawla R, Kumar A. Choroidal granuloma in one eye and scleral granuloma in the other in a case of tuberculosis. Indian J Ophthalmol 2020;68:1943-4

How to cite this URL:
Balakrishnan J, Sachan A, Chawla R, Kumar A. Choroidal granuloma in one eye and scleral granuloma in the other in a case of tuberculosis. Indian J Ophthalmol [serial online] 2020 [cited 2020 Sep 23];68:1943-4. Available from: http://www.ijo.in/text.asp?2020/68/9/1943/292554



A 27-year-old female with a history of blurring of vision in both eyes, redness, and pain in the left eye for 7 days and malaise. Her vision was 6/24 in the right eye (OD) and 6/9 in the left (OS). There was an inferonasal scleral nodule of size 2*2 mm with adjacent congestion and dilated tortuous episcleral vessels in OS [Figure 1]a. OD had an inferotemporal well-defined elevated yellowish choroidal mass of 3 disc diameter size around inferotemporal arcade surrounded by subretinal fluid [Figure 1]c. Fine-needle aspiration cytology of concurrent chest wall swellings (tubercular abscess from axillary lymph nodes) revealed epithelioid granulomas with necrosis and acid-fast bacilli. Axillary lymphadenopathy was also present. Contrast- enhanced computed tomography (CT) of chest was normal. Hemogram revealed mild lymphocytosis, serology for HIV was negative. Mantoux test was positive (14 mm at 72 hours). The patient was started on antitubercular therapy (ATT). Topical steroid drops were also initiated in OS. Oral steroids were started 1 week after starting ATT and were slowly tapered over 10 weeks.
Figure 1: (a) Left eye at presentation showing the inferonasal scleral nodule of 2*2 mm size with diffuse congestion and dilated tortuous vessels. (b) Left eye 3 months post ATT shows complete resolution of the granuloma leaving a small flat bluish lesion. (c) Fundus image of right eye at presentation shows an inferotemporal well-defined yellowish elevated choroidal mass with surrounding subretinal fluid. (d) Fundus image of right eye 3 months post-ATT shows resolution of the granuloma with choroidal thinning and scar formation. There is also the complete resolution of subretinal fluid

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At 3 months follow-up, visual acuity in both eyes was 6/6. OS showed complete resolution of the nodule leaving a small flat bluish area of thinning [Figure 1]b. OD showed resolution of exudative RD and resolution of the tuberculoma into a flat inactive scar [Figure 1]d.


  Discussion Top


Choroidal [1] and scleral [2] granulomas are well-known manifestations of disseminated tuberculosis. This is a unique case of disseminated tuberculosis affecting the anterior segment of one eye and the posterior segment of the other eye. In this case, the diagnosis of extra-pulmonary tuberculosis was confirmed by histopathology and the granulomatous ocular lesions responded well to ATT. This case highlights the variable presentations of ocular TB in two eyes of the same patient.

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.
Goel N, Kumar V, Arora S, Ghosh B. Massive choroidal granuloma as the presenting feature of disseminated tuberculosis in immunocompetent patients. Clin Exp Optom 2018;101:607-10.  Back to cited text no. 1
    
2.
Kesen MR, Edward DP, Rao NA, Sugar J, Tessler HH, Goldstein DA. Atypical infectious nodular scleritis. Arch Ophthalmol 2009;127:1079-80.  Back to cited text no. 2
    


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