Paradoxical worsening of presumed tubercular serpiginous like choroiditis on anti-tubercular therapy

Choroidal tuberculosis may present as multifocal progressive or serpiginous like choroiditis. It is important to recognize these presentations as these eyes show good response to systemic antitubercular therapy. Paradoxical reaction in tuberculosis can occur in patients receiving antituberculous therapy (ATT). It consists of clinical or radiological worsening of preexisting tuberculous lesions or the development of new lesions in patients who initially improved on treatment. Intraocular tuberculosis presents most commonly as posterior uveitis, either as choroidal tubercles, choroidal tuberculoma, subretinal abscess or serpiginous-like choroiditis; however, it can also present, in order of decreasing prevalence, as granulomatous anterior uveitis, panuveitis and intermediate uveitis. We report, a case of paradoxical worsening of presumed tubercular serpiginous like choroiditis on antitubercular therapy.Through this interesting case we try to highlight the fact that continued progression of lesions may be noted inspite of ATT and systemic steroids but it is important to be aware of paradoxical worsening, so that one doesn't interrupt ATT.