Choroidal Tuberculoma Rupesh Agrawal, Carlos Pavesio Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom

Ocular History  48 year Female  OD: complaints of decreased vision for few months  previously  bilateral acute angle closure,  bilateral intermediate and posterior uveitis 4 months prior to consultation by our team (per referral)

First Presentation - Ocular Examination  Visual acuity  OD: 6/60 OS: 6/6  AC- 1+ cells  lens clear  anterior vitreous 1+ cells

First Presentation - Fundus OD  choroidal tuberculoma temporal to fovea

First Presentation - FFA OD blocked areas of hypofluorescence with stippled late hyperfluorescence

First Presentation - FFA OD blocked areas of hypofluorescence with late hyperfluorescence

First Presentation - FFA OS  stippled hyperfluorescent lesions and no increase in size and extent of the lesion

First Presentation - ICGA  OU: hypocyanescent lesions

First Presentation - Investigations  CBC, U/E, LFT’s - normal  ACE, syphilis -negative  QuantiFERON gold - awaited  Chest X-ray - normal

First Diagnosis  Choroiditis of unclear origin  based on  clinical findings

Treatment  Prednisolone 70mg/day x 1 week

Follow-up – After 1 Week QuantiFERON Gold +ve QuantiFERON Gold +ve urgent chest physician appointment urgent chest physician appointment

New Diagnosis  Ocular Tuberculosis related choroidal granuloma  based on  clinical findings  positive QuantiFERON testing

New Treatment anti tubercular therapy started: 4 drug regime x 2 months followed by 2 drugs for 10 months anti tubercular therapy started: 4 drug regime x 2 months followed by 2 drugs for 10 months quick corticosteroid taper quick corticosteroid taper

Follow-up – After 3 Weeks  resolution of choroiditis lesions

Follow up – After 1 Month  patient started on anti-tubercular therapy  new granuloma in the left eye  continued prednisolone at 40mg/day dose along with ATT

Follow-up – After 2 Months  OU: resolution of choroidal lesions

Final Visit  ATT with corticosteroids – 12 months  Rapid response to ATT  Concurrent oral steroid therapy to achieve complete remission  Final VA: 20/20 - OU