Author: Caterina Scalcione (Spain)
Co-authors: Lucia Bascaran Oteyza, Carla Santalla Castro, Isabel Santos Rodriguez-Vigil
Purpose
We report a case series of serpiginous-like choroiditis (SLC) with different manifestation patterns.
Setting/Venue
Department of Ophthalmology, San Agustín University Hospital, Avilés, Spain
Methods
This is a retrospective case series of three patients who presented with serpiginuos-like choroiditis (SLC). The presence of choroidal lesions was identified by clinical examination and confirmed by color fundus photography, fundus autofluorescence, fluorescein angiography and optical coherence tomography. Eye symptoms, choroidal findings and systemic involvement were evaluated reaching confirmation of tuberculosis disease in all three cases. All patients received treatment.
Results
Case 1 A 45-year-old lady presented with decreased vision in her left eye. Best corrected visual acuity (BCVA) was 10/10 in her right eye, 6/10 in her left eye. Funduscopy showed multifocal, atrophic choroidal lesions in both eyes and two active lesions in the left eye, one being juxtafoveal. QuantiFERON-TB came back positive. Anti-tubercular treatment with rifampicin, isoniazid and pyrazinamide (ATT) was started and her left eye BCVA improved to 10/10. Case 2 A 42-year-old female developed nasal hemianopsia in her left eye. BCVA was 7/10. Fundus examination showed a massive temporal hyperpigmented choroidal lesion. Serology and Mantoux test were negative. Four weeks later the BCVA was of counting-fingers and the lesion had affected the fovea. The patient revealed that her mother and her husband were being treated for pulmonary tuberculosis. Chest-X-ray showed a calcified granuloma and QuantiFERON-TB was positive. ATT was started. Case 3 A 59-year-old male presented with a 2-day-history of vision loss in his left eye. BCVA was 2/10. On fundal examination, several creamy choroidal lesions were identified, as well as multiple atrophic scars, extending to lower mid-periphery. He had been treated for pulmonary tuberculosis 30 years prior. ATT was started and his BCVA improved to 4/10.
Conlusions
SCL secondary to tuberculosis has been described to have three possible choroidal manifestation patterns: 1) non-contiguous multifocal lesions with diffuse edges, 2) diffuse choroiditis with active borders and 3) multifocal lesions associated with plaque-like lesions in the fellow eye. Active lesions show progression over 4-6 weeks, sometimes despite corticosteroids or immunosuppressant treatment. These treatments may also have devastating effects because of reactivation of latent tuberculosis. ATT seems effective against active choroiditis and reduces recurrences. The presence of inflammatory cells in the anterior vitreous and the multifocality of choroidal lesions, should attract our attention to a possible tuberculosis etiology. In contrast, classic serpiginous choroiditis (CS) does not usually associate anterior vitreous inflammation and lesions typically begin from within the juxtapapillary area, spread centrifugally in a helicoidal pattern and is bilateral, although sometimes asymmetric. The angiographic pattern is similar in both clinical entities. Active lesions show early hypofluorescence and late hyperfluorescence. Atrophic or inactive lesions remain hyperfluorescent during the whole angiographic sequence. Tuberculous etiology should always be considered in choroiditis with serpiginous-like characteristics, especially in endemic areas and if QuantiFERON-TB or Mantoux tests are positive.
Financial Disclosure
The authors declare that they have no conflict of interest
Comments
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