Bilateral Optic Neuropathy as First Manifestation of Tuberculosis

Intraocular tuberculosis is a rare manifestation of Mycobacterium tuberculosis infection. We present a case of an immunocompetent male who presented with subacute binocular vision loss. On examination, he had a visual acuity of 6/10 bilaterally and optic disk edema. Initial workup was negative for structural, autoimmune, infectious or toxic etiologies. He was first treated with methylprednisolone, plasma exchange and intravenous immunoglobulin, without any clinical improvement. On the 20th day of admission, intraocular tuberculosis was presumed due to a positive interferon gamma release assay and chest tomography showing previous infection with Mycobacterium tuberculosis. He was started on an anti-tuberculosis drug regimen for 12 months, without any worsening of his visual acuity.