# Primary Tubercular Chorioretinitis Without a Pulmonary Focus: A Case Report

## TL;DR

A rare case of eye tuberculosis without lung involvement is reported, highlighting the challenges of diagnosing extrapulmonary TB in resource-limited settings.

## Contribution

This case report presents a rare instance of primary tubercular chorioretinitis without pulmonary TB in a resource-limited setting.

## Key findings

- The patient showed marked improvement in vision after starting antitubercular therapy.
- The case illustrates the diagnostic challenges of extrapulmonary TB in areas with limited access to advanced tools.
- It emphasizes the need for increased awareness of TB as a cause of ocular symptoms.

## Abstract

Ocular tuberculosis (TB) can affect various eye structures and may manifest independently of systemic TB. Typically, it arises from hematogenous dissemination from a primary focus; however, in exceptional instances, it may originate as a primary infection after epithelial injury. Diagnosing TB in an extrapulmonary site presents a significant clinical challenge. We present the case of a 33-year-old Bangladeshi female who presented with a deteriorating loss of vision in her left eye. A thorough neurologic examination and serological tests, the tuberculin skin test, a CT scan of the chest, ocular fundus photography, and optical coherence tomography were performed. Based on the clinical features and the outcome of appropriate tests, a presumptive diagnosis of ocular TB was made and later confirmed after initiating antitubercular therapy, which resulted in a marked improvement in the patient’s vision a week later. This case is an illustration of the rare nature and unusual presentation of extrapulmonary TB in the form of tubercular chorioretinitis, diagnosed in a resource-limited setting. Tubercular chorioretinitis, characterized by inflammation of the choroid and retina due to TB infection, presents a diagnostic challenge, especially in resource-limited environments where access to advanced diagnostic tools may be restricted. Therefore, this case highlights the importance of considering TB as a potential cause of ocular manifestations, even in settings where TB prevalence might not be high, and underscores the need for increased awareness and diagnostic capacity for extrapulmonary TB in resource-limited areas. This case exemplifies the infrequent occurrence and atypical manifestation, presenting a learning opportunity for future clinicians.