Tuberculous serpiginouslike choroiditis
C. Refer to the health department for 4-drug antituberculous treatment
Observation is not the preferred choice. It would be appropriate for acute posterior multifocal placoid pigment epitheliopathy (APMPPE), which might present with similar deep, plaquelike lesions; however, APMPPE is a bilateral disease in which ICGA displays uniform early- and late-phase hypofluorescence. Systemic corticosteroids followed by immunosuppression assumes this is serpiginous choroidopathy, which can present in a single eye with expanding peripapillary lesions and similar imaging but usually with less vitreous cell. Immunosuppression is not preferred owing to the need to consider other diagnoses.
Primary vitreoretinal lymphoma (PVRL) can present with creamy subretinal infiltrates with vitritis, but the cellular infiltrates are typically thick rather than atrophic. The choroid is not affected in PVRL; therefore, neuroimaging and lumbar puncture are not preferred as initial management. Additional history revealed several trips to Laos with possible exposure to tuberculosis in an endemic region. Referral for treatment of extrapulmonary tuberculosis was based on risk factors, positive interferon gamma release assay, clinical findings, and imaging. Ocular manifestations of tuberculosis serpiginouslike choroiditis (SLC) are well-described.1- 3 Tuberculosis SLC is similar to noninfectious serpiginous choroiditis in selectively damaging the inner choroid, retinal pigment epithelium, and outer retina. Helicoid or placoid lesions extend from the optic nerve head in both, but multifocal lesions and more vitreous cell are typical of tuberculosis SLC.