Background: The incidence of tuberculosis is still high in developing countries and a steady increase in new cases has been observed in industrial countries within the past decade. Among other reasons, the growing number of immunodeficient patients and migration from developing to industrial countries are both contributing factors.
Observation: A 70-year-old female patient presented with a marked decrease in visual acuity of the left eye. There was no history of tuberculosis. Funduscopy of the left eye revealed a choroidal tumor with multiple choroidal lesions, mostly located at the posterior pole, and adjacent serous retinal detachment. Ultrasonography showed a solid elevated mass; magnetic resonance imaging showed the tumor with posterior extension. Because of blindness in this eye and the presence of posterior extension, the eye was subsequently enucleated. Intraoperative observation found caseum necrosis through scleral breaking. The histological study confirmed choroidal tuberculoma. The patient developed pulmonary tuberculosis 15 days after surgery. The outcome was favorable after antibiotic treatment.
Discussion: Confirming the diagnosis of tuberculous uveitis is often difficult. The differential diagnosis includes other granulomatous ocular inflammations. The detection of Mycobacterium tuberculosis and the clinical course make this diagnosis the most likely one.
Conclusion: Choroidal granuloma is a rare and atypical location of tuberculosis. This case showed the diagnostic difficulties when there is no history of tuberculosis.