Journey of choroidal tubercle to choroidal granuloma

Abstract

Choroidal tubercles may be unilateral or bilateral and appear as a polymorphic yellowish lesion with discrete borders. Tubercles can arise early in the stages of progression of tuberculosis (TB) and are indicative of hematogenous dissemination seen in acute military TB. Choroidal granuloma is seen in chronic TB in response to antitubercular treatment. We report a case of a 14-year old girl who presented with fever, altered sensorium, and irritability for 1 week. Fundus examination revealed bilateral multiple choroidal tubercles. Antitubercular treatment was started after magnetic resonance imaging head and cerebral spinal fluid cytology confirmed the diagnosis of disseminated TB. Enhanced depth imaging optical coherence tomography was done on follow-up visits to see the stages of progression or regression of choroidal tubercle after the treatment. This is a rare case, reporting the transition of choroidal tubercle into choroidal granuloma, which is demonstrated with serial imaging using various modalities.