Serpiginous choroiditis and infectious multifocal serpiginoid choroiditis

A Case of Ampiginous Choroiditis

Purpose

Presentation of a case report of a unilateral ampiginous choroiditis.

Methods

This is an observational case report.

Results

A 70-year-old woman was referred to us with unilateral scattered chorioretinal lesions. The multifocal pattern of the lesions and the angiographic features led to the diagnosis of ampiginous choroiditis.

Conclusion

Ampiginous choroiditis is a primary inflammatory choriocapillaropathy with characteristics of both acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis.

Detection of Mycobacterium tuberculosis genome in vitreous fluid of eyes with multifocal serpiginoid choroiditis

PURPOSE

To compare 3 different molecular techniques to detect the Mycobacterium tuberculosis genome in vitreous fluid of eyes with multifocal serpiginoid choroiditis (MSC).

DESIGN

Prospective, interventional case series.

PARTICIPANTS

Eleven patients (11 eyes) with active MSC in at least 1 eye underwent diagnostic pars plana vitrectomy (PPV) between October 2012 and December 2013.

METHODS

Vitreous fluid samples were subjected to multitargeted polymerase chain reaction (PCR) for a M. tuberculosis assay, the Gene Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA), and a line probe assay (GenoType MTBDRplus; Hain Lifescience, GmbH, Nehren, Germany). The samples with positive results were subjected to rpoB gene sequencing to demonstrate rifampicin resistance. The clinical details, digital fundus imaging, and treatment details and outcomes also were noted.

MAIN OUTCOME MEASURES

Detection of the M. tuberculosis genome and rifampicin resistance in the vitreous samples.

RESULTS

Of the 11 eyes subjected to PPV, the multitargeted PCR results for tuberculosis were positive for 10 eyes, the MTBDRplus assay results were positive in 6 eyes, and the Gene Xpert MTB/RIF assay results were positive in 4 eyes. Rifampicin resistance was detected in 3 eyes by rpoB gene sequencing, in 3 eyes by the MTBDRplus assay, and in 1 eye by the Gene Xpert MTB/RIF assay.

CONCLUSIONS

We detected the M. tuberculosis genome in the vitreous fluid of eyes with MSC using 3 different molecular techniques. Rifampicin resistance was detected for the first time in eyes with MSC.

The role of methotrexate in resolving ocular inflammation after specific therapy for presumed latent syphilitic uveitis and presumed tuberculosis-related uveitis

PURPOSE

This study was designed to investigate whether the antiinflammatory and antiproliferative activity of oral and intravitreal methotrexate (MTX) suppresses intraocular inflammation in patients with presumed latent syphilitic uveitis and presumed tuberculosis-related uveitis.

METHODS

Interventional prospective study including three cases with presumed latent syphilitic uveitis treated with intravenous penicillin and oral MTX, and two cases with presumed tuberculosis-related uveitis treated with standard antituberculosis therapy and intravitreal MTX injections. Treatment efficacy of all cases was assessed by best-corrected visual acuity, fundus fluorescein angiography, and optical coherence tomography.

RESULTS

Four eyes of 3 patients with presumed latent syphilitic uveitis had improved best-corrected visual acuity, suppression of intraocular inflammation, and resolution of cystoid macular edema in 6 months with oral MTX therapy. No recurrence of intraocular inflammation was observed in 6 months to 18 months of follow-up period after cessation of MTX. Two eyes of two patients with presumed tuberculosis-related uveitis showed improved best-corrected visual acuity, suppression of intraocular inflammation, and resolution of cystoid macular edema after intravitreal injections of MTX. No recurrence of intraocular inflammation was observed in 6 months to 8 months of follow-up period after cessation of antituberculous therapy.

CONCLUSION

For the first time in the treatment of presumed latent syphilitic uveitis and presumed tuberculosis-related uveitis, we believe that MTX might have an adjunctive role to suppress intraocular inflammation, reduce uveitic macular edema, and prevent the recurrences of the diseases.

Real-time and nested polymerase chain reaction in the diagnosis of multifocal serpiginoid choroiditis caused by Mycobacterium tuberculosis - a case report

Background

The term multifocal serpiginoid choroiditis (MSC) has been proposed for the infective variant of serpiginous choroiditis (SC) to distinguish it from typical SC believed to be autoimmune related. The role of Mycobacterium tuberculosis (MTb) in MSC has been studied by conventional polymerase chain reaction (PCR). However, the use of real-time PCR (RT-PCR) and nested PCR (N-PCR) in MSC has not been reported. This paper aims to highlight the usefulness of PCR in identifying MTb as a causative agent for MSC leading to its correct treatment with anti-tubercular therapy (ATT).

Findings

A young male with a family history of tuberculosis (TB) presented with a history of diminution of vision (DOV) since 3 months in his right eye (RE). He gave similar history in his left eye (LE) since 3 years. His fundus findings were suggestive of MSC. His high-resolution computed tomography (HRCT) chest and Quanti-FERON TB gold results were positive for MTb. These suggested TB to be the likely cause for MSC. This was confirmed by a positive N-PCR report of his aqueous specimen. Further RT-PCR was done to quantify the bacillary load before starting therapy. He was advised 9 months of ATT with 6 weeks of oral steroids. At last follow-up, the RE showed better healing than the LE with fewer chorioretinal scars and a better visual acuity.

Conclusions

RT and N-PCR for MTb are useful in establishing a tuberculous etiology in MSC. Coupled with a good response to ATT, these tests justify the use of ATT in MSC with a PCR-confirmed MTb report.

Electronic supplementary material

The online version of this article (doi:10.1186/s12348-014-0029-5) contains supplementary material, which is available to authorized users.