Tuberculous Choroiditis in an Infant of Thirteen Months *

A review of the literature of recent years dealing with tuberculous choroiditis, discloses very few reports on the subject. Robin and Dickey' reported a case and stated that it was the only one seen in their clinic. Apparently there is little interest in this lesion; tuberculous choroiditis is not frequent or is overlooked. At a clinico-pathological conference in which the case of a young girl who had died of disseminated tuberculosis, and had lesions in the eye, was under discussion, Cabot' remarked, "I suppose somebody was speculating as to whether these refractile areas [seen on ophthalmological examination] in the retina could be miliary tuberdes, which we have all read about but most of us have never seen." The incidence of choroid tuberdes in wide-spread tuberculosis varies greatly according to the various discussions of the subject. Thirteen cases of tuberculous meningitis, all having choroidal miliary tubercles, were described by Marple5 in 1912 (i.e., 100 per cent in 13 cases). Carpenter and Stephenson2 could not discover tuberculous involvement of the eye in more than 50 per cent of the cases reported by them. On the other hand Heinzl4, in an examination of 41 cases of tuberculous meningitis, was unable to detect any choroidal tubercles. This last report was published in 1875, when the means of examining the fundi were crude. Had the refinements in ophthalmoscopy of later years been available then, it is probable that pathological changes would have been brought to light. In his review of 73 cases of tuberculous meningitis, Tooke7 found only seven cases of miliary tuberculosis of the choroid. This divergence of opinion in the incidence of this complication is further explained by the fact that frequent examinations are required, since in the early stages of tuberculosis of the miliary type, choroid tubercles may not be present. Tooke said that tubercles were not seen earlier than three days before death. Marple recites an incident where an examination was done at 6 P. M. with no disclosure of choroid tubercles, but four hours later he was called by the house officer, who informed him that a tubercle had been found.