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Choroidal neovascular membranes secondary to intraocular tuberculosis misdiagnosed as neovascular age-related macular degeneration

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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

DOI:10.5301/ejo.5001047

Authors

Alessandro Invernizzi, Aniruddha Agarwal, Maura Di Nicola, Fabio Franzetti, Giovanni Staurenghi, Francesco Viola

Article History

Disclosures

Financial support: No financial support was received for this submission.
Conflict of interest: Giovanni Staurenghi has financial relationships with imaging devices manufacturers including Heidelberg Engineering, Zeiss, Optovue, Nikon, and Canon. The other authors have no financial disclosures.

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Authors

Affiliations

  •  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.

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