Delayed onset macular hemorrhage following previous intraocular tuberculosis

Aims/Purpose: Mycobacterium tuberculosis , an acid‐fast‐staining bacterium, thrives in oxygen‐rich environments due to its obligate aerobe nature. Consequently, tuberculous lesions often manifest in highly oxygenated tissues. Among these tissues, the choroid stands out for its exceptionally high blood flow rate, making it a prime site for M. tuberculosis colonization. We will focus on macular hemorrhages as a complication following intraocular tuberculosis, which may have a delayed onset and arise from inactive lesions. Methods: Presentation of a clinical case. Results: We present a case involving a 58‐year‐old patient who presented to the Emergency Room with complaints of acute loss of visual acuity in her right eye. She had been immunocompromised in the past, and had a personal history of intraocular tuberculosis, which she reported had been inactive for years. On examination, her visual acuity was measured at 0.1 in the affected eye. Fundus examination revealed a macular hemorrhage surrounding a choroidal scar. There were no signs of anterior ocular involvement, vitreal inflammation, or active choroiditis. The patient was otherwise asymptomatic. Despite the lack of active lesions, a chest radiograph was performed to rule out active tuberculosis in the lungs, yielding negative results. Active tuberculosis disease was hence ruled out, as well as the need for systemic anti‐TB therapy. The patient was started on antiVEGF intravitreal injections. The patient was scheduled for follow‐up visits, and her visual acuity had improved to 0.8 in the right eye after four months. Conclusions: Choroidal neovascularization and hemorrhages are rare complications of intraocular tuberculosis, and they may arise from both active and inactive lesions. Activity can be determined by fundus examination and fluorescein angiography. Any systemic symptoms should also be recorded on the patient's history. If risen from an inactive choroidal scar, a macular hemorrhage should be treated with anti VEGF injections.