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    Choroidal Tuberculoma

    By Inês Coutinho, MD, Cristina Santos, MD, and Manuela Bernardo, MD, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portu­gal
    Photo by Susana Teixeira, Hospital Prof. Fernando Da Fonseca E.P.E., Lisbon, Portugal
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    Choroidal Tuberculoma

    A 39-year-old African woman, 30 weeks pregnant, presented in the emergency room with blurred vision in her right eye. Ocular examination revealed a well-defined yellow subretinal mass of about 2 disc diameters, located near the inferotemporal arcade in the right eye (Fig. 1). Optical coherence tomography (Fig. 2) showed serous detachment of the neurosensory retina (Fig. 2B) and an area of localized adhe­sion between the neurosensory retina and retinal pigment epithelial–choriocapillaris layer (contact sign, Fig. 2A). The differential diagnosis included ocular tuberculosis, sarcoidosis, choroidal amela­notic melanoma, and metastatic choroidal tumor.

    After 2 weeks, the patient developed dyspnea, fa­tigue, and fever. Systemic evaluation established the diagnosis of miliary tuberculosis, and a presump­tive diagnosis of ocular tuberculosis (TB) with choroidal tuberculoma was made. Antibiotics were started, but she died from septic shock shortly after giving birth to a baby at 33 weeks of gestational age and low birth weight. After delivery, the baby began treatment, but TB tests (Mantoux and interferon gamma release assay) came out negative twice. 

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