Choroidal Tuberculoma as the Presenting Sign of Extrapulmonary Tuberculosis-A Case Report

Purpose: To report case of extrapulmonary tuberculosis with choroidal tuberculoma as the presenting sign. Method: Case report. Result: A 47-year-old woman with uremia had two choroidal tumors in the left eye. A fundus examination showed the tumors were about 6×4.5×2 mm and 7×5×2 mm in size separately. They were close to each other and located at the nasal and inferior-nasal quadrant of the retina adjacent to the disc. Fluorescence angiography revealed patches of early hypofluorescence and late hyperfluorescence scattered over the area of the two tumors. Indocyanine green angiography, vitreous tuberculosis polymerase chain reaction, and serial ocular sonography were also performed. Chest radiography revealed a right pleural effusion. Computed tomography revealed wall thickening of the ascending colon with multiple regional Lymph nodes and ascites, and two osteolytic lesions at the L1 and L2 vertebrae. Magnetic resonance imaging of thoraco-lumbar spine favored tuberculosis spondylitis at the T9, T12 and L 1-3 vertebral bodies with subligmentous spreading of an abscess. A trace of acid-fast bacilli was found in the L2 spinal aspiration with a positive culture for Mycobacterium tuberculosis complex. After one year of anti-tuberculosis treatment, the choroidal lesions gradually subsided. Conclusion: Choroidal tuberculoma mimicking metastatic malignancy can be a rare presenting sign of systemic tuberculous infection and can be treated with systemic antituberculous medication.