Related Experiment Video
Updated: Mar 6, 2026
Author Spotlight: Anterior HR-OCT as a Non-Invasive Tool for Characterizing Ocular Surface Squamous Neoplasia
Published on: August 9, 2024
Inflammatory choroidal neovascular membrane after healed tuberculous choroidal granuloma
Sikander A K Lodhi1, Khadija Saifuddin1, Santhosh Devulapally1
1Sarojini Devi Eye Hospital / Osmania Medical College, Hyderabad. India.
Insights
Tuberculous granuloma can mimic intraocular tumors. While anti-tuberculous treatment heals the lesion, it can lead to choroidal neovascular membrane (CNVM) development, requiring anti-VEGF therapy.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Oncology
Background:
- Choroidal granulomas present diagnostic challenges, often mimicking intraocular tumors.
- Tuberculosis is a potential cause of choroidal granulomas, necessitating systemic evaluation.
Observation:
- A 42-year-old female presented with vision loss due to a choroidal mass, initially suspected as a tumor.
- Positron emission tomography (PET) scan revealed enlarged lymph nodes, and biopsy confirmed caseating granulomas consistent with tuberculosis.
Findings:
- Anti-tuberculous treatment led to granuloma resolution and vision improvement, forming a scar.
- Six months post-treatment, a choroidal neovascular membrane (CNVM) developed at the scar margin, causing vision deterioration.
- Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections successfully resolved the CNVM.
Implications:
- Accurate diagnosis of tuberculous granuloma requires a high index of suspicion and comprehensive systemic workup.
- PET scans are valuable for identifying suitable lymph nodes for biopsy in suspected cases.
- Close monitoring of healed tuberculous choroidal lesions is crucial for early detection and management of post-inflammatory CNVM.
Abstract:
Objective: To present a case of choroidal granuloma masquerading as intraocular tumor that healed on anti-tuberculous treatment but led to the development of inflammatory choroidal neovascular membrane (CNVM). Method: A 42-year-old female patient with past history of hysterectomy presented with diminution of vision in the right eye. Fundus examination in the right eye showed a yellowish white choroidal mass with associated bullous retinal detachment superotemporal to fovea. Left eye fundus was normal. Fundus flourescein angiography showed early and late hyperflourescence with late pooling in serous detachments. Complete systemic evaluation did not yield a clue to diagnosis. Positron emission tomography scan (PET scan) showed enlarged lymph nodes in cervical, mediastinal and peritoneal regions. Lymph node biopsy showed caseating granulomas. Results: The granuloma subsided and a scar formed 5 months after starting anti-tuberculous treatment with improvement in vision. Six months later, the vision deteriorated again with the development of a choroidal neovascular membrane (CNVM) at the margin of the scar. The CNVM resolved and all the signs of activity subsided after giving intravitreal antivascular endothelial growth factor (anti-VEGF) injections. Conclusions: Making a diagnosis of tuberculous granuloma in a case of choroidal mass lesion is a challenge. PET scan helps in identifying metabolically active lymph nodes appropriate for biopsy. Healed scars of tuberculous choroid lesions should be followed closely to detect the development of CNVM.
