A 42-year-old female patient presented with a history of diminution of vision in the right eye for fifteen days. She had no other systemic complaints. She had undergone hysterectomy for an indication of dysfunctional uterine bleeding a year and a half ago. On examination, she had best corrected visual acuity of 20/400 in the right eye and 20/20 in the left eye. Both eyes anterior segment examination was within normal limits. Fundus examination of the right eye showed a yellowish white subretinal mass lesion six to eight disc diameters in size, located at the superotemporal arcade, just reaching the fovea with an overlying exudative detachment (Figure 1 (Fig. 1)). Left eye fundus was normal. The differential diagnosis included choroidal metastasis, choroidal tuberculoma or amelanotic melanoma. Because of hysterectomy in the recent past, the possibility of choroidal metastases was strongly considered. 
Fundus flourescein angiography showed an early hyperflourescence in the region of the lesion with progressive increase in hyperflourescence and pooling of the dye outlining the serous detachment by late phases (Figure 2 (Fig. 2)). Ultrasonography showed a mass lesion of uniform echogenecity with low internal reflectivity (Figure 3 (Fig. 3)).
The patient was referred to the physician for systemic evaluation. The patient underwent chest radiography, Mantoux test, complete blood picture, erythrocyte sedimentation rate (ESR) and HIV test. Positron emission tomography (PET) scan was advised by the physician. Chest x-ray was normal, Mantoux test (with 5 IU of purified protein derivatives) showed 15 mm induration. Erythrocyte sedimentation rate (ESR) was more than 20 mm. PET scan (Figure 4 (Fig. 4)) reporting was presence of multiple 18F-fluorodeoxyglucose (FDG) avid nodes (up to level IV) in cervical, mediastinal and retroperitoneal region - suggestive of an inflammatory pathology (tuberculosis) or metastases. Fine needle aspiration biopsy (FNAC) of cervical lymph node was inconclusive. Cervical lymph node biopsy showed caseous necrotic inflammation probably of tuberculous etiology. There was no evidence of neoplasia (Figure 5 (Fig. 5)). AFB culture of lymph nodes did not show any growth of acid fast bacilli.
The patient was started on four drug anti-tuberculosis treatment (isoniazid, rifampicin, etambutol, pyrazinamide with pyridoxine) with oral prednisolone (1 mg/kg body weight). Oral corticosteroids were tapered after the first four weeks and were stopped within eight weeks. The lesion started showing healing from the edges within two weeks after starting anti-tuberculous treatment (ATT) (Figure 6 (Fig. 6) and Figure 7 (Fig. 7)).
At ten-month follow-up, the scarred granuloma was stable with a visual acuity of 6/12p. A month later, still on ATT, the patient reported diminution of vision in the right eye, with best corrected visual acuity (BCVA) falling to 6/36p in RE. RE fundus examination showed macular edema with subretinal blood and exudates adjacent to the scar of the previous choroidal granuloma (Figure 8 (Fig. 8)). Fundus fluorescein angiography (FFA) showed patchy hypoflourescence due to subretinal blood and exudates and mild diffuse late leakage due to juxtafoveal CNVM. Spectral domain optical coherence tomography (SD-OCT) showed an increased foveal thickness, a dome-shaped hyperreflectivity at the level of the retinal pigment epithelium (RPE) and adjacent intraretinal cystic changes indicative of an active CNVM. 
After informed consent, intravitreal anti-vascular endothelial growth factor (anti-VEGF) (Bevacizumab) was given. The CNVM resolved after four intravitreal Bevacizumab (Avastin) injections, leaving a scar with BCVA of 6/36 (Figure 9 (Fig. 9)).