Miliary tuberculosis and bilateral multifocal choroidal involvement: place of indocyanine green angiography.

PURPOSE

To present the clinical features and angiographic findings of choroidal involvement in two cases with miliary tuberculosis.

METHODS

49-year and 23-year-old men were hospitalized for fever of unknown origin and they received a diagnosis of miliary tuberculosis following the systemic work-up. Both cases experienced mild visual acuity disturbances prior to initiation of systemic treatment. They underwent full ophthalmological examination including fluorescein and indocyanine green angiography.

RESULTS

The visual acuity of first case was 20/30 in OD, and 20/25 in OS. There was trace of cells in the anterior chamber and mild vitritis OU. Visual acuity of the second case was 20/20 OU. Anterior segment was unremarkable OU. Ophthalmoscopy of both cases showed cream-colored patchy choroidal infiltrations especially located at the posterior pole OU. Fluorescein and indocyanine green angiographies were obtained with Heidelberg scanning laser ophthalmoscope. These lesions were hypofluorescent in early phases of fluorescein angiography and demonstrated gradually increased hyperfluorescence in late phases. Same lesions were hypofluorescent throughout the indocyanine green angiography and well delineated. Both patients received a systemic treatment of isoniazid, rifampicin, ethambutol and morphazinamide. Most of the choroidal lesions resolved without apparent changes whereas some healed as chorioretinal scars.

CONCLUSION

In patients with miliary tuberculosis, indocyanine green angiography seems to show choroidal involvement much better than the fluorescein angiography and may be a more important diagnostic tool than fluorescein angiography during the disease course.