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Zhou L, Hu B, Xu ZP. A case of solitary choroidal tuberculoma with highly positive tuberculin skin test and negative interferon gamma release assays. Int J Ophthalmol 2024; 17:969-972. [PMID: 38766335 PMCID: PMC11074187 DOI: 10.18240/ijo.2024.05.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/01/2023] [Indexed: 05/22/2024] Open
Affiliation(s)
- Lin Zhou
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan Province, China
| | - Bin Hu
- Department of Ophthalmology, Chengdu Tianfu New District People's Hospital, Chengdu 641400, Sichuan Province, China
| | - Zhu-Ping Xu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Dedina L, Little M, Durkin S. TUBERCULOUS CHORIORETINITIS: A CHALLENGING CASE OF AN OPHTHALMIC MIMIC. Retin Cases Brief Rep 2023; 17:430-432. [PMID: 37364203 DOI: 10.1097/icb.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
PURPOSE To report a challenging case of tuberculous chorioretinitis. METHODS Case report of a 51-year-old woman from the Middle East, who was referred from an optometrist with a suspicious retinal lesion in her right eye. RESULTS Clinical examination showed multifocal, pale, elevated lesions temporal to the right macula with no vasculitis or hemorrhages. Infective and inflammatory workup showed unremarkable results. B-scan ultrasound confirmed an 8 mm × 3 mm × 10 mm right focal chorioretinal thickening. Computed tomography scanning showed calcified lung hilar nodes supporting a prior granulomatous process, along with an enhancing nodule in the right globe. Magnetic resonance imaging of the brain and obits showed retinal thickening of the temporal surface of the right globe with subtle enhancement without retrobulbar extension or evidence for cerebral vasculitis. Subretinal lesion biopsy showed mononuclear inflammatory cells with granulomatous inflammation, including multinucleated giant cells but no neoplastic features. Interferon-gamma release assay testing for tuberculosis showed negative result, but a high index of suspicion lead to tuberculin skin testing and subsequent treatment for tuberculous chorioretinitis. CONCLUSION Ocular tuberculosis presents in a variety of ways, making it a challenging diagnosis. Herein, we describe such case of tuberculous chorioretinitis.
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Affiliation(s)
- Liana Dedina
- Ophthalmology Unit, The Queen Elizabeth Hospital, Woodville, South Australia
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Lee DH, Cho H, Lee J, Choi EY, Lee SC, Kim M. Clinical features and long-term treatment outcomes in choroidal tuberculoma. Graefes Arch Clin Exp Ophthalmol 2021; 260:1641-1650. [PMID: 34735633 DOI: 10.1007/s00417-021-05474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To investigate the clinical features and treatment outcomes of patients with choroidal tuberculoma. METHODS In this retrospective, observational case series, the medical records of five patients with choroidal tuberculoma who were followed up at a university hospital for at least 6 months were analyzed. RESULTS Of five patients, one was male and four were female. The overall mean age was 38.0 ± 9.4 years (mean follow-up: 41.2 ± 33.8 months). Tuberculin skin test was performed in three patients, and it was positive in two of them. Interferon-gamma assay was performed in two patients and was positive in all two. Three patients had systemic tuberculosis involving the lung or other organs. Five patients were treated with antitubercular therapy for a period of 9.6 ± 8.6 months. Systemic corticosteroid treatment was performed in 3 patients, with a period of 3.5 ± 0.7 months. One patient with a recurrent vascularized tuberculoma was successfully treated with single intravitreal bevacizumab injection. CONCLUSION Choroidal tuberculoma can develop without evidence of systemic tuberculosis and can recur despite antitubercular treatment. High index of suspicion is important in early detection, and management of choroidal tuberculoma. In cases of suspected choroidal tuberculoma, positive results on immunological tests would be sufficient to initiate antitubercular therapy even if radiological evidence of systemic tuberculosis is not found. Antitubercular therapy combined with systemic corticosteroids provided favorable results. Intravitreal injection of anti-vascular endothelial growth factor may be considered for highly vascularized choroidal tuberculoma.
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Affiliation(s)
- Dong Hyun Lee
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, 06273.,Department of Ophthalmology, Inha University Hospital, Inha University College of Medicine, 27, Inhangro, Jung-gu, Incheon, Republic of Korea
| | - Hyuna Cho
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, 06273
| | - Junwon Lee
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, 06273
| | - Eun Young Choi
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodongro, Seo-gu, Daejeon, Republic of Korea
| | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, 06273.
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Ying JEJ, Tang CS, Hanapi MS, Ngoo QZ, Hitam WHW. Unilateral choroidal tuberculoma as an initial manifestation of presumed ocular tuberculosis: a case report. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Radiology of Abnormal Globe Contour. Clin Neuroradiol 2021; 31:943-951. [PMID: 34170369 DOI: 10.1007/s00062-021-01049-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
The orbits are easily identified on routine computed tomography (CT) and magnetic resonance imaging (MRI) imaging of the head and neck. Although there are many structures within the orbits, the overall structure of the globe is the most noticeable and can be an important source for pathology. In particular, many disease processes alter globe morphology and it is imperative that the radiologist be aware of not only the most common, but uncommon etiologies as well. This article provides an image-rich review of the wide range of emergent and non-emergent pathology that can result in altered globe contour.
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A Solitary Choroidal Mass with Spontaneous Resolution. Case Rep Ophthalmol Med 2021; 2020:8882617. [PMID: 33381337 PMCID: PMC7748891 DOI: 10.1155/2020/8882617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/19/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background To report an atypical case of a transient choroidal mass lesion with spontaneous resolution. Case Presentation. A solitary choroidal mass with an overlying neurosensory retinal detachment was seen in an otherwise healthy 31-year-old female. General physical examinations and serum chemistry were unremarkable. The patient had spontaneous resolution two weeks after initial examination without treatment. Conclusions Inflammatory choroidal masses may be self-limited, but complete diagnostic measures must always be performed in these patients to distinguish between important causes such as tuberculosis, sarcoidosis, and tumors.
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Bazán Henostroza MA, Curo Melo KJ, Nishitani Yukuyama M, Löbenberg R, Araci Bou-Chacra N. Cationic rifampicin nanoemulsion for the treatment of ocular tuberculosis. Colloids Surf A Physicochem Eng Asp 2020. [DOI: 10.1016/j.colsurfa.2020.124755] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Aksoy FE, Altan C, Basarir B. Multimodal imaging of a choroidal granuloma as a first sign of tuberculosis. Photodiagnosis Photodyn Ther 2020; 29:101580. [DOI: 10.1016/j.pdpdt.2019.101580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/06/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
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Agarwal A, Aggarwal K, Gupta V. Infectious uveitis: an Asian perspective. Eye (Lond) 2019; 33:50-65. [PMID: 30315262 PMCID: PMC6328604 DOI: 10.1038/s41433-018-0224-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 02/06/2023] Open
Abstract
Several intraocular infections can present with protean manifestations posing major diagnostic and management challenges. Infections such as tuberculosis, dengue and chikungunya fever have continued to remain major endemic diseases that are associated with uveitis in the Asia Pacific region. These entities often require a high index of clinical suspicion and laboratory analysis including assays of ocular fluids and/or tissues for confirmation of the diagnosis. Infectious uveitis caused by tuberculosis, dengue and chikungunya can present with characteristic clinical features and imaging findings on ancillary investigations; that may provide clue to the early diagnosis. Use of modern imaging modalities such as enhanced-depth imaging optical coherence tomography, optical coherence tomography angiography and ultra-wide field fundus photography greatly aid in the evaluation of these conditions. In the current review, we have discussed the epidemiology, clinical phenotypes, imaging characteristics, diagnosis and management of uveitis caused by tuberculosis, dengue and chikungunya.
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Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanika Aggarwal
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Asensio-Sánchez VM, Díaz-Cabanas L, Martín-Prieto A, Haro-Álvarez B. Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2018; 93:147-150. [PMID: 28743416 DOI: 10.1016/j.oftal.2017.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 05/27/2017] [Accepted: 06/21/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection. CASE REPORT The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy. DISCUSSION Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab.
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Affiliation(s)
- V M Asensio-Sánchez
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España.
| | - L Díaz-Cabanas
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
| | - A Martín-Prieto
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
| | - B Haro-Álvarez
- Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España
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