CHOROIDAL TUBERCULOMA IN PREGNANCY

Isolated uveal tuberculoma masquerading as an intraocular tumor in an immunocompetent patient-a clinical-pathologic study with diagnosis by PCR

Purpose

The aim of this article is to report a case of uveal tuberculoma simulating an intraocular tumor in which the diagnosis was only possible by polymerase chain reaction (PCR) analysis.

Method

This is a case report.

Results

A36-year-old male presented with a progressive growing intraocular tumor and no history or positive test for other systemic disease. The eye eventually turned blind and painful and was enucleated. Histopathologic analysis revealed a granulomatous reaction and caseation necrosis but failed to identify any causative microorganisms. Final tuberculosis diagnosis was only possible by quantitative PCR.

Conclusion

Isolated uveal tuberculoma can present in an otherwise healthy patient with negative systemic tuberculosis evaluation. PCR can be used to confirm tuberculosis when other methods have failed.

Tuberculosis

PURPOSE OF REVIEW

The purpose of this report is to present an update on the manifestations and management of ocular tuberculosis.

RECENT FINDINGS

Tuberculosis affects one-third of the world's population. The incidence of tuberculosis has increased with the increase in the HIV infected population. Following a resurgence of the disease in the US, the incidence has recently declined. Patients may develop scleritis that can be focal, nodular or diffuse with or without keratitis. Anterior granulomatous uveitis may occur. The posterior segment reveals vitritis, choroiditis, and can mimic serpiginous choroiditis and other entities. Patients who are immunosuppressed or HIV infected may develop active mycobacterial disease in the eye leading to rapid destruction of the ocular structures. The diagnosis of ocular tuberculosis is made by isolation of Mycobacterium tuberculosis on Löwestein-Jensen medium or by PCR. The diagnosis is supported by the clinical findings, imaging techniques including optical coherence tomography, fluorescein angiography, indocyanine green and ultrasonography. Tuberculin skin test helps to confirm the diagnosis.

SUMMARY

Ocular tuberculosis may occur in the absence of pulmonary disease. Patients present with a spectrum of clinical signs. The disease may mimic several clinical entities. Early diagnosis and prompt treatment of ocular tuberculosis may prevent ocular morbidity and blindness.