Photodynamic therapy as an adjunct to systemic treatment in a case with unilateral presumed vascularized choroidal tuberculous granuloma

Intraocular tuberculosis cannot be diagnosed easily in some clinical circumstances. A 29-year-old otherwise healthy woman who was initially misdiagnosed and treated empirically with systemic steroids and sulfamethoxazole–trimethoprim for toxoplasmosis was referred to us for severe visual loss. We instituted quadruple antituberculosis treatment upon chest medicine consultation as all attempts, including consecutive intravitreal antibiotic injections, could not prevent the enlargement of lesion. Systemic antituberculosis treatment halted the fulminant course but the granuloma became vascularized. Because photodynamic therapy (PDT) has very recently been shown to reduce viable mycobacterial cells in animal experiments we performed PDT, and the vascularized tuberculous granuloma was successfully treated. PDT may have an antimycobacterial effect besides its well-known antiangiogenic effect.