Rare ocular manifestation of papilledema and bilateral choroidal tubercles in disseminated miliary tuberculosis

Abstract

An 11-year-old female on treatment for miliary tuberculosis presented with decreased vision. Examination revealed bilateral disc edema, granulomatous uveitis, and multiple choroidal tubercles. Oral steroids were added. She was lost to follow-up, and 3 months later she had further visual loss due to optic atrophy. Repeat imaging of the CNS showed regression of the brain parenchymal lesions. This is a rare presentation of ocular tuberculosis in the setting of disseminated TB. While the mainstay of therapy is antitubercular therapy, this case highlights the importance of systemic corticosteroids to decrease both ocular and CNS inflammation and halt further vision loss.