Choroidal Neovascularization in Choroidal Tuberculoma: A Case Report
Author: Kristine Go Pormida (Philippines)
Co-authors: Jocelyn Sy, Jessica Marie Abaño, Erika Jean Salvame
To present a case of a choroidal neovascularization associated with choroidal tuberculoma in a young Filipino female.
A 28 year old female complained of sudden blurring of vision of the left eye. Right eye was generally unremarkable. Slit-lamp examination of the left eye showed presence of 2+ cells in anterior vitreous. Posteriorly, the left eye revealed a subretinal yellowish elevated lesion approximately of 2-disc diameter in size seen at the superior arcade parafoveal area with surrounding subretinal fluid extending to foveal area. Fluorescein angiogram and Optical Coherence Tomography showed a localized choroidal tuberculoma. Systemic and laboratory work up revealed elevated Erythrocyte Sedimentation Rate (ESR) and a positive Pureprotein Derivative (PPD) Skin test. Other results were unremarkable. The patient was started with anti-tubercular therapy and oral corticosteroids which provided minimal improvement on symptoms. Further examination using OCT angiogram revealed presence of choroidal neovascular membrane. Patient was started with 3 doses of Bevacizumab injection that siginificantly improve visual acuity and resolution of the choroidal neovasculrization.
Choroidal neovascularization is a rare occurrence in ocular Tuberculosis and misdiagnosis can happen. High index of suspicion in patients presenting with unexplained occurrence of worsening visual symptoms and further investigation using ICGA and OCTA can early detect accurate diagnosis and initiate immediate management in such cases. Careful and thorough fundus examinations, long term monitoring of CNV in every follow-up and a combination of ATT, corticosteroids and local intravitreal Bevacizumab injection can provide better disease control and visual prognosis.
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