TB choroiditis presenting like Birdshot retinochoroidopathy Rupesh Agrawal, Carlos Pavesio Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom Ocular History 82 year old, healthy male referred by optician for follow up history of choroidal lesions first noted 10 years ago. General History history of lung infection 2004 CXR showed some granulomatous lesions CXR showed some granulomatous lesions diagnosed with active mycobacterium- avium intracellulaire (sputum culture) diagnosed with active mycobacterium- avium intracellulaire (sputum culture) S/p treatment with rifampin, pyrazinamide, isoniazid x 1 year S/p treatment with rifampin, pyrazinamide, isoniazid x 1 year First Presentation - Examination visual acuity OD 6/9 OS 6/9 anterior chamber: D/Q lens: PCIOL OU anterior vitreous: +0.5 cells OU First Presentation - Fundus fundus showing presence of birdshot choroiditis like lesions First Presentation - Infrared OU: hyperfluorescent dots First Presentation - FFA OU: hyperfluorescent lesions First Presentation - ICGA OU: hyperfluorescent lesions on ICGA Past history and clinical pictures What did he look like in the past? 2008 photos Fundus in 2008 OU: fundus showing multiple choroidal lesions Differential Diagnosis Multifocal choroiditis Sarcoidosis Birdshot Chorioretinopathy Old TB? MAC choroiditis? First Presentation - Investigations CBC, U/E, LFTs all normal HLA A-29 negative ACE normal QuantiFERON gold + CXR: evidence of old granulomatous lesions Final Diagnosis TB-associated chorioretinitis Based on: Chest X-ray findings QuantiFERON testing Clinical findings Follow up After 6 Months patient referred back to chest physicians and TB clinic to rule out active TB. patient referred back to chest physicians and TB clinic to rule out active TB. cross reactivity of QuantiFERON-gold test? cross reactivity of QuantiFERON-gold test? no evidence of TB or active mycobacterium avium cellulaire no evidence of TB or active mycobacterium avium cellulaire no treatment needed no treatment needed