Presumed tubercular retinal vasculitis with serpiginous-like choroiditis in the other eye

A 17-year old boy, with decreased vision in right eye for 15 days, presented with retinal periphlebitis in multiple quadrants of the right eye and partially active serpiginous-like choroiditis in the left eye. Tuberculin test was positive (16 mm induration), and chest X-ray showed hilar lymphadenopathy. The patient was treated with a 9-month course of anti-tubercular therapy and a tapering dose of oral corticosteroids. Both retinal vasculitis and choroiditis lesions resolved over 3-4 months. Retinal neovascularization in the right eye was treated with laser photocoagulation. There was no recurrence over an 18-month follow-up. The probable pathogenic mechanism for such a presentation is discussed.