Lodhi Sikander A K, Saifuddin Khadija, Devulapally Santhosh
Sarojini Devi Eye Hospital / Osmania Medical College, Hyderabad. India.
GMS Ophthalmol Cases. 2017 Mar 3;7:Doc06. doi: 10.3205/oc000057. eCollection 2017.
To present a case of choroidal granuloma masquerading as intraocular tumor that healed on anti-tuberculous treatment but led to the development of inflammatory choroidal neovascular membrane (CNVM). A 42-year-old female patient with past history of hysterectomy presented with diminution of vision in the right eye. Fundus examination in the right eye showed a yellowish white choroidal mass with associated bullous retinal detachment superotemporal to fovea. Left eye fundus was normal. Fundus flourescein angiography showed early and late hyperflourescence with late pooling in serous detachments. Complete systemic evaluation did not yield a clue to diagnosis. Positron emission tomography scan (PET scan) showed enlarged lymph nodes in cervical, mediastinal and peritoneal regions. Lymph node biopsy showed caseating granulomas. The granuloma subsided and a scar formed 5 months after starting anti-tuberculous treatment with improvement in vision. Six months later, the vision deteriorated again with the development of a choroidal neovascular membrane (CNVM) at the margin of the scar. The CNVM resolved and all the signs of activity subsided after giving intravitreal antivascular endothelial growth factor (anti-VEGF) injections. Making a diagnosis of tuberculous granuloma in a case of choroidal mass lesion is a challenge. PET scan helps in identifying metabolically active lymph nodes appropriate for biopsy. Healed scars of tuberculous choroid lesions should be followed closely to detect the development of CNVM.
报告一例伪装成眼内肿瘤的脉络膜肉芽肿病例，该病例经抗结核治疗后愈合，但导致了炎性脉络膜新生血管膜（CNVM）的形成。一名42岁有子宫切除史的女性患者出现右眼视力下降。右眼眼底检查显示在黄斑中心凹颞上方有一个黄白色脉络膜肿物，并伴有大泡性视网膜脱离。左眼眼底正常。眼底荧光血管造影显示早期和晚期高荧光，浆液性脱离处有晚期荧光素渗漏。全面的系统评估未得出诊断线索。正电子发射断层扫描（PET扫描）显示颈部、纵隔和腹膜区域的淋巴结肿大。淋巴结活检显示干酪样肉芽肿。开始抗结核治疗5个月后，肉芽肿消退并形成瘢痕，视力有所改善。6个月后，视力再次下降，瘢痕边缘出现脉络膜新生血管膜（CNVM）。玻璃体内注射抗血管内皮生长因子（抗VEGF）后，CNVM消退，所有活动迹象均消失。在脉络膜肿物病变病例中诊断结核性肉芽肿具有挑战性。PET扫描有助于识别适合活检的代谢活跃淋巴结。结核性脉络膜病变的愈合瘢痕应密切随访，以检测CNVM的发生。
