Intraocular tuberculosis (IOTB) can be complicated by choroidal neovascularization (CNV). However, when the CNV development is not accompanied by clear signs of inflammation, the etiology can be missed, especially in countries nonendemic for tuberculosis. We describe the clinical and imaging features of CNVs presenting as the first sign of IOTB initially misdiagnosed as exudative age-related macular degeneration (AMD).
A retrospective review of clinical and imaging data of patients initially misdiagnosed with neovascular AMD later diagnosed with inflammatory CNV secondary to IOTB at tertiary referral centers was conducted. Features of fundus photography, fluorescein angiography, indocyanine green angiography, and enhanced depth imaging optical coherence tomography were analyzed. Distinguishing features between neovascular AMD and IOTB-associated CNV were evaluated.
Five patients over 55 years of age, erroneously diagnosed with exudative AMD, were included in the study. Multimodal imaging analysis allowed identification of peculiar choroidal alterations such as choroidal granulomas or choroiditis suggestive for posterior uveitis. Systemic workup for granulomatous uveitis including immunologic investigations such as tuberculin skin test or QuantiFERON TB Gold® and radiologic investigations revealed tubercular etiology in all the cases, allowing correct diagnosis and management of the uveitis and related CNV.
Choroidal neovascularization represents a rare and unusual presenting sign of IOTB that can be misleading especially when it occurs in the elderly living in countries with low prevalence of the disease. Multimodal imaging can be helpful and should be employed, especially in atypical cases of CNV, in order to avoid misdiagnosis and/or diagnostic delays.
Post author correction
Article Type: ORIGINAL RESEARCH ARTICLE
Article Subject: Uveitis
AuthorsAlessandro Invernizzi, Aniruddha Agarwal, Maura Di Nicola, Fabio Franzetti, Giovanni Staurenghi, Francesco Viola
- • Accepted on 13/09/2017
- • Available online on 26/10/2017
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- Invernizzi, Alessandro [PubMed] [Google Scholar] 1, * Corresponding Author (firstname.lastname@example.org)
- Agarwal, Aniruddha [PubMed] [Google Scholar] 2
- Di Nicola, Maura [PubMed] [Google Scholar] 3
- Franzetti, Fabio [PubMed] [Google Scholar] 4
- Staurenghi, Giovanni [PubMed] [Google Scholar] 1
- Viola, Francesco [PubMed] [Google Scholar] 3
Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco,” Luigi Sacco Hospital, University of Milan, Milan - Italy
Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh - India
Department of Clinical Sciences and Community Health, Ophthalmological Unit, University of Milan, IRCCS Cà Granda Foundation-Ospedale Maggiore Policlinico, Milan - Italy
Department of Clinical Sciences, Section of Infectious and Tropical Diseases, Luigi Sacco Hospital, University of Milan, Milan - Italy
Alessandro Invernizzi and Aniruddha Agarwal contributed equally to this work and share the first authorship.