Purpose

To report three cases of birdshot chorioretinopathy initially misdiagnosed as ocular tuberculosis

Methods

Retrospective review of the charts of three patients.

Results

The study included two females and one male patients. The ages were respectively 45, 45 and 33 years. One patient had a family history of pulmonary tuberculosis. All three patients initially had multifocal choroiditis and angiographic retinal vasculitis. Work-up showed positive QuantiFERON-TB Gold and tuberculin skin test in all three cases. An initial diagnosis of tubercular uveitis was made and the patients received a nine-month regimen of antitubercular therapy associated with systemic steroids. On follow up, patients developed recurrence of inflammation with mild vitritis and peripapillary bilateral creamy ovoid choroidal lesions that were highly suggestive of birdshot chorioretinopathy. The anterior chamber was calm in all cases. Macular edema was noted in two cases. HLA A-29 typing was positive in all three patients. A final diagnosis of birdshot chorioretinopathy was established after a delay ranging from 1 year to 4 years from the disease onset. Patients were prescribed systemic corticosteroids and conventional immunosuppressive therapy.

Conclusions

Birdshot chorioretinopathy is a rare cause of uveitis in North Africa. Thus, careful analysis of clinical findings and multimodal imaging results are mandatory not to miss the diagnosis particularly in patients with latent tuberculosis in this endemic area for tuberculosis.