Resolution of a choroidal granuloma in an immunocompetent adult

A 32-year-old immunocompetent male presented with painless progressive vision loss in the right eye. Left eye findings were unremarkable. Right eye fundus showed a yellowish choroidal mass nasal to the disc with para-foveal pigmentation and subretinal fluid [Fig. 1a and b]. Systemic investigations for tuberculosis were negative. Based on clinical findings and epidemiologic context, a presumptive diagnosis of possible ocular tuberculosis manifesting as a choroidal granuloma was considered.[1] The patient was started on empirical anti-tubercular therapy with oral corticosteroids which led to complete resolution of the lesion as seen on his 6-week follow-up fundus photograph [Fig. 1c and d]. The best corrected visual acuity improved from 6/36 to 6/9 on the Snellen chart.Figure 1: (a) Right eye fundus photograph showing a well-demarcated, dome-shaped elevation of a choroidal granuloma nasal to the optic disc and para-foveal pigmentation. (b) Optical coherence tomography of the superior junction of the granuloma and surrounding retina showing subretinal fluid. (c) Follow-up at 6 weeks after initiation of anti-tubercular therapy and oral corticosteroids; there is complete resolution of the lesion. (d) Optical coherence tomography through the identical meridian demonstrates the resolution of the choroidal granulomaAuthors’ contributions Dr Harsh H. Jain: Concept, Data acquisition (imaging), Manuscript preparation, Literature review. Dr Tanya Sagar — Literature search, Manuscript editing. Dr Aditya Kelkar — Supervising Surgeon, Critical revision and Final approval of manuscript. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.