A 32-year-old man presented to our clinic with decreased vision in his left eye. He had a history of pulmonary tuberculosis, which had been treated 9 years prior and declared cured.

Fundus examination revealed Bouchut tubercles and a choroidal granuloma at the posterior pole (Figure 1). OCT imaging showed a hyporeflective, dome-shaped lesion (Figure 2, blue arrow), with an overlying attachment between the retinal pigment epithelium-choriocapillaris layer and the neurosensory retina, consistent with the contact sign (Figure 2, white arrow), a finding described by Salman et al in 2006.1

<p>Figure 1</p>

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Figure 1

<p>Figure 2</p>

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Figure 2

The presence of the contact sign is suggestive of a choroidal tuberculoma and contrasts with the OCT features observed in noninflammatory conditions, such as choroidal tumors found in cases of melanoma, metastasis, or circumscribed hemangioma. Management for this case included initiating systemic antitubercular therapy in coordination with infectious disease specialists, along with close ophthalmologic monitoring.

1. Salman A, Parmar P, Rajamohan M, Vanila CG, Thomas PA, Jesudasan CA. Optical coherence tomography in choroidal tuberculosis. Am J Ophthalmol. 2006;142(1):170-172.