Serpiginoid choroiditis associated with presumed ocular tuberculosis

The purpose of this study is to present a case with serpiginoid choroiditis with possible ocular tuberculosis. The intraocular inflammation and choroiditis were successfully controlled by systemic antituberculosis treatment. A 63-year-old female presented with progressive bilateral blurred vision for over a year. At presentation, her best-corrected visual acuity was 6/20 in her right eye and counting fingers at 10 cm in her left eye. A fundus examination showed diffuse patchy geographic retinal pigment epithelium (RPE) changes with some pigmentation in both eyes. Fluorescein angiography disclosed leakage from RPE lesions and discs as well as retinal vasculitis. Systemic survey results for rheumatic and infectious diseases were normal except for a positive QuantiFERON-TB Gold test result. Her uveitis improved and chorioretinal lesions stabilized from the 2nd month of antituberculosis treatment. The antituberculosis treatment was discontinued after a 12-month course. No recurrence of uveitis was noted during the following 2 months. Diagnosing ocular tuberculosis is challenging. The clinical presentation, interferon-gamma release assay test, and clinical response to antituberculosis therapy can support a presumed diagnosis of tubercular uveitis. This case highlights that serpiginoid choroiditis can be a clinical presentation of ocular tuberculosis. Clinicians should pay attention to this etiology when facing a serpiginous-like retinal appearance.