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. • Tuberculosis (TB)-associated posterior segment diseases of the eye had a wide spectrum of manifestations and most of phenotypes involved both choroid and retina. • We reported a rare case with presumed ocular TB masquerading as manifestation of autoimmune retinopathy (AIR), in which the damage only limited to outer retina. The visual function of the patient improved significantly after initial anti-tuberculosis (ATT) monotherapy followed by combination with steroid treatment at 12-month follow-up. • Active infections such as TB must be ruled out prior to the diagnosis of real AIR or any attempt to utilize steroids and other immunosuppressive medications.