Disseminated Mycobacterium haemophilum Infection Complicating Immunosuppressive Therapy in HLA-A29 Positive Birdshot Chorioretinopathy: Case Report

Introduction: This case describes the clinical course and management of birdshot chorioretinopathy in a patient who developed disseminated Mycobacterium (M.) haemophilum infection while on long-term systemic immunomodulatory therapy (IMT), highlighting the role of local corticosteroid therapy when systemic agents are contraindicated. Case Presentation: A 74-year-old male with stable birdshot chorioretinopathy maintained on adalimumab and mycophenolate mofetil developed progressive cutaneous lesions and systemic symptoms, ultimately diagnosed as disseminated M. haemophilum. Systemic IMT was discontinued, resulting in reactivation of intraocular inflammation. Due to the ongoing infectious process contraindicating IMT, local corticosteroid therapies were utilized to control ocular inflammation while mitigating systemic risk. The patient also experienced herpetic epithelial keratitis and steroid-induced ocular hypertension following local corticosteroid therapy, necessitating antiviral therapy and IOP-lowering drops. With multidisciplinary care, intraocular inflammation and vision were stabilized. Conclusions: This case highlights the complexities of managing vision-threatening uveitis in the setting of systemic opportunistic infections, limiting the ability to utilize systemic IMT. Local corticosteroid delivery may offer effective control in such scenarios but carries their own risks.