Bilateral choroidal mass: Are we dealing with tuberculosis?

Abstract

Abstract A 27 year old female was undergoing treatment for suspected viral meningitis in medicine department and referred for eye examination for decrease in vision in left eye. Fundus examination showed multiple bilateral choroidal mass with a normal anterior segment. Fundus fluorescein angiography (FFA) was confirmatory for bilateral choroidal granuloma and with a provisional diagnosis of miliary tuberculosis, High-resolution computed tomography (HRCT) thorax and contrast-enhanced magnetic resonance imaging (CEMRI) brain was done which revealed miliary mottling in both lungs with vertebral involvement and ring lesions with focal asymmetric enhancement respectively. A diagnosis of bilateral multifocal choroiditis with choroidal tubercular granuloma was established following a positive Mantoux report. Hence, unilateral or bilateral mass lesions should not be missed as a possibility of tubercular granuloma with or without systemic presentation in Indian subcontinent.