Karim A, Laghmari M, Boutimzine N, Lamarti A, Ibrahimy W, Essakali N, Daoudi R, Mohcine Z
Service d'Ophtalmologie A.
J Fr Ophtalmol. 2003 Jun;26(6):614-7.
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.
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.
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.
Choroidal granuloma is a rare and atypical location of tuberculosis. This case showed the diagnostic difficulties when there is no history of tuberculosis.
发展中国家结核病发病率仍然很高，在过去十年中，工业化国家的新病例数呈稳步上升趋势。免疫功能低下患者数量的增加以及从发展中国家向工业化国家的移民都是促成因素。
一名70岁女性患者左眼视力明显下降。无结核病病史。左眼眼底检查发现脉络膜肿瘤，伴有多个脉络膜病变，主要位于后极，并伴有相邻的浆液性视网膜脱离。超声检查显示实性隆起肿块；磁共振成像显示肿瘤向后延伸。由于该眼失明且存在向后延伸，随后进行了眼球摘除术。术中观察发现通过巩膜破裂处有干酪样坏死。组织学研究证实为脉络膜结核瘤。患者术后15天发生肺结核。抗生素治疗后预后良好。
确诊结核性葡萄膜炎往往很困难。鉴别诊断包括其他肉芽肿性眼部炎症。结核分枝杆菌的检测和临床病程使该诊断成为最有可能的诊断。
脉络膜肉芽肿是结核病罕见且非典型的发病部位。该病例显示在无结核病病史时诊断存在困难。
