J Korean Ophthalmol Soc.  2017 Jan;58(1):50-55. 10.3341/jkos.2017.58.1.50.

The Clinical Manifestations and Differential Diagnosis of Tuberculosis Serpiginous-like Choroiditis and Serpiginous Choroiditis

• Ahn SH
• Cho NC
• Ahn M
• You IC
• Jeong JG

• KMID: 2367841
• DOI: http://doi.org/10.3341/jkos.2017.58.1.50

Abstract

PURPOSE
The purpose of this study is to make a distinction between tuberculous serpiginous-like choroiditis and serpiginous choroiditis, and compare their clinical manifestations.
METHODS
We retrospectively reviewed thirty eight eyes of twenty-six patients who visited our institution and were diagnosed with serpiginous choroiditis from January 2005 to December 2014. The patients were divided into two groups, tuberculosis serpiginous- like choroiditis (Tb-SLC) and classic serpiginous choroiditis (classic SC), and were analyzed based on the treatment response, previous history of Bacillus Calmette-Guérin (BCG) vaccination, positive results of tuberculin skin test (TST), chest X-ray, anterior and fundus examination, and fluorescein angiography (FAG).
RESULTS
Twenty seven eyes of eighteen patients were serpiginous choroiditis and eleven eyes of eight patients were tuberculosis serpiginous-like choroiditis. There were no significant differences in age, sex, or previous history of BCG vaccination between the two groups. The positive result of the tuberculin skin test and abnormality in the chest X-ray were shown to be significantly higher in the Tb-SLC group. Multi-focal lesions involving periphery observed in fundus examination and FAG were significantly higher in Tb-SLC.
CONCLUSIONS
In tuberculosis endemic areas such as Korea, tuberculosis serpiginous-like choroiditis should be considered as a differential diagnosis when the patient is suspicious of serpiginous choroiditis. The understanding of various clinical manifestations of tuberculosis serpiginous-like choroiditis may derive accurate diagnosis and treatment, enhancing patient's prognosis.

Keyword

Serpiginous choroiditis; Tuberculosis serpiginous-like choroiditis

MeSH Terms

Bacillus
Choroid*
Choroiditis*
Diagnosis
Diagnosis, Differential*
Fluorescein Angiography
Humans
Korea
Mycobacterium bovis
Prognosis
Retrospective Studies
Skin Tests
Thorax
Tuberculin
Tuberculosis*
Vaccination
Tuberculin

Figure

• 

  Figure 1. Indocyanine green angiography (ICGA) and fluorescein angiography (FAG) of the patients. ICGA and FAG of tuber-culosis serpiginous-like choroiditis showing wide spread multifocal lesions (A, B), ICGA and FAG of serpiginous choroiditis show-ing large solitary lesion that extends from the juxta-papillary area (C, D).

Reference

References

1. Tabbara KF. Tuberculosis. Curr Opin Ophthalmol. 1961; 66:111–24.

2. Sheu SJ, Shyu JS, Chen LM, et al. Ocular manifestations of tuberculosis. Ophthalmology. 1961; 66:111–24.

3. Lim WK, Buggage RR, Nussenblatt RB. Serpiginous choroiditis. Surv Ophthalmol. 1961; 66:111–24.

4. Gupta V, Gupta A, Arora S, et al. Presumed tubercular serpiginous-like choroiditis: clinical presentations and management. Opthalmology. 1961; 66:111–24.

5. Vasconcelos-Santos DV, Zierhut M, Rao NA. Strengths and weak-nesses of diagnostic tools for tuberculous uveitis. Ocul Immunol Inflamm. 1961; 66:111–24.

6. Gupta A, Bansal R, Gupta V, et al. Ocular signs predictive of tu-bercular uveitis. Am J Ophthalmol. 1961; 66:111–24.

7. Vasconcelos-Santos DV, Rao PK, Davies JB, et al. Clinical features of tuberculous serpiginouslike choroiditis in contrast to classic ser-piginous choroiditis. Arch Ophthalmol. 1961; 66:111–24.

8. World Health Organization. Global tuberculosis report 2015. 20th ed.Geneva: World Health Organization;2015; 1–7.

9. Sarvananthan N, Wiselka M, Bibby K. Intraocular tuberculosis without detectable systemic infection. Arch Ophthalmol. 1998; 116:1386–8.

10. Stechschulte SU, Kim RY, Cunningham ET Jr. Tuberculous neuroretinitis. J Neuroophthalmol. 1961; 66:111–24.

11. Kotake S, Kimura K, Yoshikawa K, et al. Polymerase chain re-action for the detection of Mycobacterium tuberculosis in ocular tuberculosis. Am J Ophthalmol. 1961; 66:111–24.

12. Lee JY, Kang KW, Shin JP, et al. Rapidly progressing foveal atro-phy with tuberculous serpiginous-like choroiditis despite com-bined anti-tuberculosis and steroid Treatment. J Korean Ophthalmol Soc. 1961; 66:111–24.

13. Biswas J, Madhavan HN, Gopal L, Badrinath SS. Intraocular tuberculosis. Clinicopathologic study of five cases. Retina. 1995; 15:461–8.

14. Barondes MJ, Sponsel WE, Stevens TS, Plotnik RD. Tuberculous choroiditis diagnosed by chorioretinal endobiopsy. Am J Ophthalmol. 1961; 66:111–24.

15. Gupta V, Gupta A, Sachdeva N, et al. Successful management of tubercular subretinal granulomas. Ocul Immunol Inflamm. 2006; 14:35–40.

16. Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuber-culin skin tests: what is the absolute effect of BCG and non-tuber-culous mycobacteria? Int J Tuberc Lung Dis. 1961; 66:111–24.

17. Mazurek GH, Jereb J, Lobue P, et al. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuber-culosis infection, United States. MMWR Recomm Rep. 2005; 54:49–55.

18. Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med. 2000; 161:(4 Pt 2). S221–47.

19. Wang L, Turner MO, Elwood RK, et al. A meta-analysis of the ef-fect of Bacille Calmette Guérin vaccination on tuberculin skin test measurements. Thorax. 1961; 66:111–24.

20. Dinnes J, Deeks J, Kunst H, et al. A systematic review of rapid di-agnostic tests for the detection of tuberculosis infection. Health Technol Assess. 1961; 66:111–24.

21. Jeong YJ, Lee KS. Pulmonary uberculosis: up-to-date imaging and management. AJR Am J Roentgenol. 1961; 66:111–24.

22. Shin CH, Lee SN. Atypical ocular and optical coherence tomo-graphic findings with presumed miliary tuberculosis. J Korean Ophthalmol Soc. 1961; 66:111–24.