1. TB choroiditis presenting like Birdshot retinochoroidopathy Rupesh Agrawal, Carlos Pavesio Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom

2. Ocular History  82 year old, healthy male  referred by optician for follow up  history of choroidal lesions first noted 10 years ago.

3. 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

4. First Presentation - Examination  visual acuity  OD 6/9 OS 6/9  anterior chamber: D/Q  lens: PCIOL OU  anterior vitreous: +0.5 cells OU

5. First Presentation - Fundus  fundus showing presence of birdshot choroiditis like lesions

6. First Presentation - Infrared  OU: hyperfluorescent dots

7. First Presentation - FFA  OU: hyperfluorescent lesions

8. First Presentation - ICGA  OU: hyperfluorescent lesions on ICGA

9. Past history and clinical pictures What did he look like in the past? 2008 photos

10. Fundus in 2008  OU: fundus showing multiple choroidal lesions

11. Differential Diagnosis  Multifocal choroiditis  Sarcoidosis  Birdshot Chorioretinopathy  Old TB?  MAC choroiditis?

12. First Presentation - Investigations  CBC, U/E, LFT’s all normal  HLA A-29 negative  ACE normal  QuantiFERON gold +  CXR: evidence of old granulomatous lesions

13. Final Diagnosis  TB-associated chorioretinitis  Based on:  Chest X-ray findings  QuantiFERON testing  Clinical findings

14. 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