Central serous chorioretinopathy secondary to latent tuberculosis in a hypertensive patient: A case report

To report a rare case of central serous chorioretinopathy (CSCR) associated with systemic tuberculosis (TB) in a hypertensive patient, and its resolution following antitubercular therapy (ATT). A 43-year-old man with a history of high blood pressure visited the eye clinic because his left eye had been blurry for about a month and a half. His vision with glasses was normal in his right eye (6/6) but reduced in his left eye (6/12). The pressure inside both eyes and the front parts of his eyes appeared normal during examination. However, when the fundus seen, there was a fluid buildup under the retina in the central part (macula) of his left eye. Additionally, both eyes showed some signs of damage to the blood vessels due to his high blood pressure (grade 2 hypertensive retinopathy). An OCT scan of his left eye confirmed fluid under the retina in the macula, with the thickness of this central area measuring 240 micrometers. Fundus autofluorescence revealed hypo autofluorescent areas suggestive of chronic retinal pigment epithelium (RPE) alterations. Fluorescein angiography (FFA) showed focal points of hyper fluorescence in the macular region, consistent with CSCR. The patient was initiated on oral eplerenone 25 mg twice daily. Systemic evaluation to identify secondary causes of hypertension and possible underlying etiology revealed a strongly positive Mantoux test and a positive interferon-gamma release assay (IGRA), indicating latent tuberculosis infection. The patient was subsequently started on a full course of ATT. Over the following weeks, there was complete resolution of subretinal fluid and restoration of macular architecture on OCT. This case underscores the importance of systemic evaluation in atypical or persistent presentations of CSCR. Tuberculosis may act as a systemic trigger for CSCR in predisposed individuals, possibly via inflammatory or vascular mechanisms.