|Year : 2020 | Volume
| Issue : 3 | Page : 169-170
Optical coherence tomography angiography in miliary tuberculosis
Department of Ophthalmology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
|Date of Submission||19-May-2020|
|Date of Decision||26-Jul-2020|
|Date of Acceptance||09-Aug-2020|
|Date of Web Publication||2-Nov-2020|
Dr. Salil Mehta
Department of Ophthalmology, Lilavati Hospital and Research Center, A 791, Bandra Reclamation, Bandra, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
A 14-year-old female was admitted with a history of high-grade fever. On admission, she underwent a comprehensive clinical, laboratory, and radiological evaluation. A contrast-enhanced computed tomography (CT) scan of the chest revealed multiple, tiny, nodular opacities in a ground-glass pattern bilaterally. Sputum studies were positive for Mycobacterium tuberculosis. Dilated fundus examination revealed multiple, yellow-white, deep choroidal lesions consistent with choroidal tubercles. She underwent optical coherence tomography angiography (OCTA) in both eyes, which revealed normal superficial and deep retinal plexuses but multiple areas of flow void in the choriocapillaris. The optical coherence tomography (OCT) sections showed hyperreflective areas in the choriocapillaris/superficial choroid with absence of choriocapillaris circulation.
Keywords: Ocular, tubercles, tuberculosis
|How to cite this article:|
Mehta S. Optical coherence tomography angiography in miliary tuberculosis. Oman J Ophthalmol 2020;13:169-70
A 14-year-old female with no known comorbidities was admitted with a history of high-grade fever (up to 104°) for the last 20 days. There was no significant diurnal variation, and it was accompanied by a dry cough with scanty expectoration and dyspnea. Relevant past history included a mild weight loss (1 kg) in the last week. She underwent a comprehensive clinical, laboratory, and radiological evaluation. Significant clinical findings included tachycardia and tachypnea with reduced air entry bilaterally. A contrast-enhanced CT scan of the chest revealed multiple, tiny, nodular opacities in a ground-glass pattern bilaterally, suggestive of an infectious process [Figure 1]. Subsequent sputum studies were positive for M. tuberculosis via GeneXpert ® testing. As part of a regular institutional protocol for pyrexia, she underwent an ocular evaluation. Her visual acuity was 20/20 bilaterally with normal anterior segments. Dilated fundus examination revealed multiple, yellow-white, deep, choroidal lesions scattered throughout the posterior pole, consistent with choroidal tubercles [Figure 2]. She underwent baseline OCTA with a DRI OCT Triton Plus (Topcon Medical, Oakland, NJ, USA) in conjunction with Imagenet 6 (ver. 3.0.1; Topcon Medical System, Oakland, NJ), which revealed normal superficial and deep retinal plexuses but multiple areas of flow void in the choriocapillaris [Figure 3]. The OCT sections corresponding to these areas showed hyperreflective areas in the choriocapillaris/superficial choroid with absence of choriocapillaris circulation [Figure 4]. A safe and reproducible procedure, OCTA, uses a series of high-speed B-scans with subsequent signal processing (decorrelation evaluation) to provide graphic and quantitative information about the retinal and choroidal circulation. It is useful in cases of vasculitis (assessment of capillary nonperfusion) and macular lesions (edema, neovascularization) and in the identification of choroidal granulomas (tuberculosis and sarcoidosis). It may also play an important role in tubercular serpiginous choroiditis. Use of OCTA may assist in the detection of granulomas and associated vasculitis as well as in monitoring their resolution, potentially avoiding the risks of invasive angiographies.
|Figure 1: Computed tomography scan of the chest showing multiple, tiny, nodular opacities in both lung fields|
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|Figure 2: Color fundus photograph of the left eye showing multiple choroidal tubercles in the posterior pole|
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|Figure 3: Optical coherence tomography angiography of the choriocapillaris layer showing areas of flow void corresponding to the visible tubercles (arrow shows a single selected tubercle)|
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|Figure 4: Optical coherence tomography scan with false color flow overlay at the level of the studied tubercle (indicated by vertical marker). The tubercle appears as a hyperreflective area with a slight elevation of the retinal pigment epithelium complex. The retinal circulation (red) appears normal, but the choriocapillaris/superficial choroidal circulation (purple) shows distinct loss of flow signal within the tubercle|
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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
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dingerkus VL, Munk MR, Brinkmann MP, Freiberg FJ, Heussen FMA, Kinzl S, et al
. Optical coherence tomography angiography (OCTA) as a new diagnostic tool in uveitis. J Ophthal Inflamm Infect 2019;9:10.
Hah YY, Keane PA, Ho SL, Agarwal R. Optical coherence tomography angiography of choroidal neovascularization associated with tuberculous serpiginous-like choroiditis. Ocul Immunol Inflamm 2016;24:699-701.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]