Primary tubercular chorioretinitis: A case report.

Area of Science:

• Ophthalmology
• Infectious Diseases
• Immunology

Background:

• Intraocular tuberculosis (TB) diagnosis is often delayed due to nonspecific clinical signs and lack of systemic manifestations.
• Ocular TB can lead to irreversible vision loss if not promptly diagnosed and treated.

Purpose of the Study:

• To report a rare case of primary tubercular chorioretinitis in an immunocompetent patient.
• To highlight a distinctive imaging hallmark for early diagnosis of intraocular TB.
• To emphasize the importance of multimodal imaging and immunologic testing in managing ocular TB.

Main Methods:

• Case report of a young, immunocompetent woman with acute vision loss.
• Utilized multimodal imaging to assess intraocular inflammation and structural changes.
• Conducted systemic workup and interferon-gamma release assay (IGRA).
• Initiated standard four-drug antitubercular therapy with adjunctive oral corticosteroids.

Main Results:

• Multimodal imaging revealed active inflammation within pre-existing chorioretinal atrophy, alongside retinal vasculitis and choroidal hypoperfusion.
• Systemic workup was negative for extrapulmonary TB, but IGRA was strongly positive.
• Treatment led to complete resolution of intraocular inflammation and significant visual recovery.
• No recurrence was observed during long-term follow-up.

Conclusions:

• Intralesional reactivation within chorioretinal atrophy is a potential imaging hallmark for intraocular TB.
• Early diagnosis and treatment of ocular TB are critical to prevent vision loss.
• Multimodal imaging and IGRA are valuable tools for diagnosing ocular TB, even in immunocompetent individuals with isolated ocular symptoms.