Case Study: Resolving Diagnostic Uncertainties in the Clinical Presentation of Ocular Tuberculosis

Case No. 1

A 62 year-old female patient reported to our hospital in January 2012, complaining of blurring of vision and floaters in left eye for 2 months. There were recurrent episodes of the same complaints in the past; the visual acuity in her left eye was 6/9 and that in her right eye was6/6. Anterior segments were normal. Fundus examination revealed patches of active choroiditis disseminated all over the fundus of left eye. On fundus fluorscein angiography hypofluoroscence with late staining was seen. Mantoux was strongly positive (16mm) along with lymphocytosis. Intravenous Methyl prednisolone 1 gm was given for 3 days along with four drugs anti-tubercular treatment (Rifampicin 600mg, INH 300mg, Ethambutol 800mg, Pyrazinamide 1500mg) in addition to maintenance systemic steroids in tapering doses. Lesions healed completely in four weeks. There had been no recurrence even after 2years after completion of treatment.

Figure 1.

Fundus photograph of left eye, showing active lesion of choroiditis in upper nasal quadrant