Tubercular Serpiginous-like Choroiditis is a rare intraocular inflammation affecting the retinal pigment epithelium and the choroid in a creeping snake-like pattern. This study presents a rare case of Tubercular Serpiginous-like Choroiditis in an adult Filipino male, its clinical manifestations, diagnostic and therapeutic management.
A 59 year old male presented with painless, gradually progressive blurring of vision of the right eye. A complete ophthalmologic examination was performed.
The best corrected visual acuity on presentation was at 20/138, with no anterior chamber activity. Funduscopy revealed trace vitritis and subretinal hypopigmented placoid lesions at the peripapillary area extending centrifugally, involving the macular area. There was early hypofluorescence of the lesions with late dye leakage of the edges of the lesions on fluorescein angiography. Tuberculin skin testing and TB quantiferon showed positive results, while chest x-ray revealed a lesion suggestive of Tuberculosis. The patient was treated with anti-tuberculous therapy (ATT) for six months and prednisone at 1 mkday, tapered gradually. Post-treatment, indocyanine green angiography showed healing of the placoid lesions with areas of well delineated blocked hypocyanescence, while OCT-angiography showed vascular tissue loss of the outer retinal layers, and fundus autofluorescence showed gradually fading autofluorescence.
Tubercular Serpiginous-like Choroiditis is rare and vision-threatening especially when the macula is affected. Multimodal imaging is helpful in the early diagnosis and treatment monitoring. It is essential to rule out infectious causes, as treatment may differ. Timely initiation of ATT and concomitant corticosteroid therapy are the keys to preventing vision loss and disability.