title: Bilateral multiple choroidal granulomas and systemic vasculitis as presenting features of tuberculosis in an immunocompetent patient.
abstract: BACKGROUND
  Multiple choroidal granulomas are a rare presentation of tuberculosis. Choroidal granulomas in immunocompetent patients can pose difficulty in diagnosis as in most cases systemic examination may not reveal any evidence of tuberculosis. We report a case of bilateral multiple choroidal granulomas with systemic vasculitis-like features and disseminated tuberculosis in an immunocompetent patient without pulmonary involvement.
  
  
  RESULTS
  A 26-year-old male Indian patient presented with bilateral blurred vision and systemic illness with vasculitis-like features. Examination revealed bilateral multiple choroidal granulomas and multisystem involvement without pulmonary involvement. Aqueous tap was positive for mycobacterium by polymerase chain reaction along with tissue biopsy leading to diagnosis. There was a good systemic and ocular response to anti-tubercular therapy with resolution of lesions.
  
  
  CONCLUSIONS
  Our case emphasizes that, although uncommon, tuberculosis can involve multiple organs without pulmonary involvement and may mimic systemic vasculitis, it is not mandatory to have pulmonary findings for a confirmation of tuberculosis. Timely diagnosis with appropriate treatment can improve systemic and ocular disease.
authors: Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, 600006, India.
authors: Nitin
authors: N
authors: Kumar
authors: Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, 600006, India. drdharshan@gmail.com.
authors: Sridharan
authors: S
authors: Sudharshan
authors: Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, 600006, India.
authors: Sudha K
authors: SK
authors: Ganesh
authors: Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, 600006, India.
authors: Gopal
authors: G
authors: Lingam
authors: Medical and Vision Research Foundations, Sankara Nethralaya, 18, College Road, Chennai, 600006, India.
authors: Jyotirmay
authors: J
authors: Biswas
keywords: Anti-tubercular therapy; Extra pulmonary tuberculosis; MPB64 genome; Multiple choroidal granulomas; Polymerase chain reaction; Systemic vasculitis