Purpose: To report a case of tuberculosis-related serpiginous-like choroiditis (TB-SLC)
in Denmark in a patient with few risk factors. Methods: Single case report. Results:
A 54-year-old Caucasian male with no relevant travel history presented with unilateral
light placoid confluent elements in the macula of the right eye with a best-corrected
visual acuity of 0.2 Snellen. The left eye was normal. Wide-field Fluorescein and
Indocyanine green-angiography were performed, and findings were consistent with acute
posterior multifocal placoid pigment epitheliopathy. Since the condition was considered
sight-threatening, and the patient had no recognizable risk factors for tuberculosis
(TB), he was prescribed 50 mg of oral prednisolone. Blood tests and an X-ray were
ordered to exclude infectious causes. The first interferon-gamma release assay (IGRA)
test was inconclusive and a new test was ordered. Over the following weeks new white
dots appeared in the retina. After the patient had been treated for seven weeks with
prednisolone, the second IGRA came back positive, and he was diagnosed with TB-SLC.
Upon repeated questioning two months after baseline, the patient remembered that ten
years ago he had been in a workplace with 50 different nationalities, and seven years
ago he had been in contact with a friend who was treated for latent TB, thus supporting
relevant exposure. Conclusion: TB-SLC may occur even in a patient with few recognizable
risk factors and in a setting that is not TB endemic. It is imperative to continuously
reassess differential diagnoses and initiate or repeat paraclinical testing in cases
with atypical features.
