Presumed Ocular tuberculosis masquerading as autoimmune retinopathy

To report a case of tuberculosis (TB) infection with an unusual posterior segment manifestation that mimicked autoimmune retinopathy (AIR).

A 36-year-old male presented with blurred vision and constriction of visual field (VF) in both eyes for over 2 weeks. Multimodal imaging suggested he had AIR-like retinopathy; however, the initial local/systemic steroid treatment worsened his condition. He later tested positive for TB infection and received one month of anti-tuberculosis (ATT) monotherapy, followed by combined steroid treatment for an additional 5 months. He was followed up 12 months after treatment, demonstrating significantly improved visual function and restoration of macular anatomy.

This case underscores the need to consider intraocular TB as a potential mimic of AIR, highlighting the importance of ruling out active infections before diagnosing AIR.