Department of Ophthalmology, University Hospital Centre, University of Split School of Medicine, Split, Croatia.
Med Sci Monit. 2011 Jul;17(7):CS88-90. doi: 10.12659/msm.881839.
Tuberculosis is a world-wide public health problem which may clinically present in many different ways. Here we report on a patient with presumed serpiginous choroiditis (PSC) found to have latent ocular tuberculosis.
The clinical history and physical examination, complete blood count, erythrocyte sedimentation rate, chest radiograph, fundus fluorescein angiography, tuberculin skin test, serological tests, and systemic evaluation carried out by consultant internist of a 42-year-old man with PSC were evaluated. The patient presented with gradual painless loss of central vision in his left eye and dark rings in the central visual field of the right eye. Upon examination, he was found to have 1 round choroidal lesion centered in the left macula and multiple serpiginous-like choroidal lesions in the right eye. Based on positive tuberculin skin test result, the patient was initially treated with anti-tubercular therapy combined with systemic corticosteroids. An immunosuppressive agent (Azathioprine) was consequently administered due to unsatisfactory response to initial therapy and the vicinity of the pathological process to the right fovea.
It is important to remember that tubercular choroiditis may present with clinical features of serpiginous choroiditis, requiring timely and appropriate therapy and close observation in order to prevent the progression of visual loss and recurrences.
结核病是一个全球性的公共卫生问题，可能以多种不同的方式在临床上表现出来。在这里，我们报告了一例疑似匐行性脉络膜炎（PSC）的患者，经检查发现患有潜伏性眼部结核。
对一名 42 岁男性患者的临床病史和体格检查、全血细胞计数、红细胞沉降率、胸部 X 光片、眼底荧光素血管造影、结核菌素皮肤试验、血清学检查以及内科顾问进行的系统评估进行了评估。该患者出现左眼无痛性中心视力逐渐丧失和右眼中央视野出现暗环。检查发现他的左眼黄斑中心有 1 个圆形脉络膜病变，右眼有多个匐行样脉络膜病变。由于结核菌素皮肤试验阳性，患者最初接受了抗结核治疗联合全身皮质类固醇治疗。由于初始治疗反应不佳且病变靠近右眼黄斑，因此给予免疫抑制剂（硫唑嘌呤）。
重要的是要记住，结核性脉络膜炎可能表现为匐行性脉络膜炎的临床特征，需要及时和适当的治疗以及密切观察，以防止视力丧失和复发的进展。
