ESCRS - P237 - CHOROIDAL TUBERCULOMA: THE ONLY REVEALING SIGN OF ISOLATED OCULAR TUBERCULOSIS IN AN IMMUNOCOMPETENT CHILD

CHOROIDAL TUBERCULOMA: THE ONLY REVEALING SIGN OF ISOLATED OCULAR TUBERCULOSIS IN AN IMMUNOCOMPETENT CHILD

Published 2022 - 26th ESCRS Winter Meeting

Reference: P237 | Type: Abstracts | DOI: 10.82333/4m2k-m983

Authors: Asmae Guechati* 1 , MOHAMMED TAOUS 1 , MOHAMMED ATMANI 1 , RKIA AZAHRAI 1 , WISSALE OUJIDI 1 , SIHAM CHARIBA 1 , ASMAE MAADANE 1 , RACHID SEKHSOUKH 1

1CHU MOHAMMED VI,OUJDA.MOROCCO,OUJDA,Morocco

Purpose

Ocular tuberculosis can manifest itself in different forms, including choroidal tuberculoma, a rather rare form with little expressive symptoms.

Setting

Choroidal tuberculoma is a rare form of ocular tuberculosis, presenting less frequently in patients without evidence of systemic disease.

The diagnosis of choroidal tuberculoma is facilitated by several paraclinical examinations, in particular optical coherence tomography, which shows the fusion of the retinal pigment epithelium (RPE) layer with the neurosensory retina on the granuloma, defining the "contact sign"

The retinal angiography, as for it, makes it possible to highlight the presence of hypo fluorescent lesions at the early time which, at the late time, become hyper fluorescent. 

At the same time, angiography also plays an important role in eliminating differential diagnosis. These include choroidal hemangiomas, foreign bodies, melanomas and secondary metastatic tumors. 
Thus, neuroretinitis due to tuberculosis should rule out other etiologies such as bartonellosis, syphilis, Lyme disease, toxoplasmosis and sarcoidosis.
Treatment is based on first-line antibacillary drugs for 6 to 12 months combined with systemic corticosteroids. Systemic corticosteroids have been shown to have potential for reducing inflammation in ocular tuberculosis.

Methods

The case of an 11 year old child is presented, with no notable pathological history, who has been suffering from myodesopsia of the right eye for 10 days 

Results

The visual acuity was 10/10th with normal examination of the appendages and the anterior segment bilaterally. The fundus was unremarkable in the left eye but showed a yellowish choroidal lesion in the inferior temporal region with exudates forming a macular star in the right eye.

The patient underwent an optical coherence tomography which revealed a homogeneous and hypo-reflective choroidal lesion in the shape of a dome leading to an elevation of the hyper-reflective retina with discontinuity of the retinal pigmentary epithelium.

Angiography showed a small area of hypofluorescence in the early phase, retaining fluorescein in the late phase.
An intradermal tuberculin reaction with quantiferon was performed and came back positive. 
The search for koch's bacilli (BK) in the sputum was negative as well as the different serologies.
Radiologically, the chest X-ray was normal, completed by a CT scan of the cervix, thorax, abdomen and pelvis (CTAP), showing adenomegaly on the upper and lower diaphragm. 
The patient also underwent an optical resonance imaging (MRI) of the cerebro-orbital region which came back without any abnormalities.
On this, the child was put on antibacillary drugs for a period of 6 months which could be prolonged, with a general corticosteroid therapy..

Conclusion

The diagnosis of tuberculosis remains a challenge, particularly in ocular tuberculosis, based on a combination of clinical and paraclinical evidence.