Enhanced Depth Imaging-Spectral Domain-Optical Coherence Tomography imaging of choroidal tubercles with multiple pigment epithelial detachments in a case of miliary tuberculosis

Choroidal tubercles in miliary tuberculosis have been rarely reported. A 65-year-old male diagnosed with miliary tuberculosis was started on antitubercular therapy (ATT) and referred for fundus screening, which revealed lesions suggestive of choroidal tubercles and pigment epithelial detachments (PEDs), confirmed by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). Choroidal tubercles were identified in Enhanced Depth Imaging-Spectral Domain-Optical Coherence Tomography (EDI-SD-OCT) as nodular hyperreflective lesions with thickening of overlying choriocapillaris– Retinal Pigment Epithelium (RPE)–Bruch's complex, myoid–ellipsoid junction disruption, and increased choroidal thickness. Choroidal thickening and PED decreased following ATT. EDI-SD-OCT is the investigative tool of choice to identify choroidal tubercles and inflammation. EDI-SD-OCT can be utilized as a biomarker in choroidal studies. PED may result due to choroidal inflammation.