Coats-like response in tubercular subretinal abscess masquerading as melanoma as the initial manifestation of miliary tuberculosis

• Main Authors: Nivedita Nair, Sreelakshmi Kummamuri, S Sudharshan, Vikas Khetan
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Indian Journal of Ophthalmology
• Subjects: antitubercular treatment; choroidal mass; coats'-like response; miliary tuberculosis; subretinal abscess; ocular tuberculosis; choroidal melanoma
• Online Access: http://www.ijo.in/article.asp?issn=0301-4738;year=2020;volume=68;issue=9;spage=2040;epage=2043;aulast=Nair

Ocular neoplasia can masquerade as an inflammatory condition and vice-versa, which if untreated, can lead to loss of vision or even life. We present a young immunocompetent adult male referred to us as choroidal melanoma. He had a large atypical choroidal mass and exudative retinal detachment. He had no systemic complaints and ocular lesions were the first manifestation of disseminated disease. Aqueous polymerase chain reaction for Mycobacterium tuberculosis (MTB) was negative, but Mantoux, chest radiology, acid-fast bacilli, and caseation necrosis on pleural nodule histopathology confirmed tuberculosis (TB). While on antitubercular therapy, a rare “Coats'-like response” was noted which eventually resolved completely with treatment.