Vianna Raul N G, Vanzan Vinicius, da Fonsêca Maria Luisa Gois, Cravo Leonardo
Retina and Vitreous Unit, Department of Ophthalmology, Fluminense Federal University, Marques do Parana Avenue 303 Centro, Niterói, RJ, 24033-900, Brazil.
Int J Retina Vitreous. 2021 Jan 4;7(1):1. doi: 10.1186/s40942-020-00272-7.
Classic serpiginous choroiditis (SC) usually begins in the peripapillary area and spreads centrifugally, however, in some patients, the lesion can arise in the macular region. An association between lesions resembling classic SC and tuberculosis was recognized as a possibly distinct clinical entity and named as tuberculous serpiginous-like choroiditis. The differentiation of this tuberculous entity from SC is critical because the treatment of the former with immunosuppressive drugs leads to several potential adverse effects, and such treatment can have devastating consequences because of the worsening of a concomitant tuberculous infection.
A 31-year-old woman presented with unilateral decreased vision and a fundus examination consistent with macular serpiginous choroiditis. A non-reactor tuberculin skin test and normal thoracic CT scan ruled out tuberculosis. However, after 2 months of treatment with steroids and immunosuppressive drugs, the contralateral eye developed similar lesions, further raising the suspicions of ocular tuberculosis. We conducted QuantiFERON® TB Gold, which was positive; hence, antituberculous therapy was started on the patient. The lesions started healing within a few weeks. After 1 year of finishing the therapy, the lesions remained healed without any recurrence.
Macular serpiginous-like choroiditis may be the initial presentation of presumed ocular tuberculosis. Nevertheless, the correct diagnosis of this entity can be challenging and delayed by the imprecise results from the currently available methods.
经典匐行性脉络膜炎（SC）通常始于视乳头周围区域并离心性扩散，然而，在一些患者中，病变可出现在黄斑区。与经典SC相似的病变和结核病之间的关联被认为是一种可能独特的临床实体，并被命名为结核性匐行性脉络膜炎样病变。将这种结核性病变与SC区分开来至关重要，因为用免疫抑制药物治疗前者会导致多种潜在不良反应，而且由于并发结核感染的恶化，这种治疗可能会产生毁灭性后果。
一名31岁女性因单侧视力下降就诊，眼底检查符合黄斑匐行性脉络膜炎。结核菌素皮肤试验无反应且胸部CT扫描正常排除了结核病。然而，在用类固醇和免疫抑制药物治疗2个月后，对侧眼出现了类似病变，进一步增加了眼结核的怀疑。我们进行了结核感染T细胞检测（QuantiFERON® TB Gold），结果呈阳性；因此，开始对该患者进行抗结核治疗。病变在几周内开始愈合。完成治疗1年后，病变持续愈合且无任何复发。
黄斑匐行性脉络膜炎样病变可能是疑似眼结核的初始表现。然而，由于现有方法结果不准确，对该实体的正确诊断可能具有挑战性且会延迟。
