Intraocular tuberculosis often evades diagnosis owing to its nonspecific clinical features and frequent absence of systemic signs. We describe a rare case of primary tubercular chorioretinitis in an immunocompetent woman in her early 20s who presented with acute vision loss, ocular pain, and redness in the left eye. Multimodal imaging demonstrated active inflammation arising within-not at the margin of-pre-existing focal chorioretinal atrophy, accompanied by retinal vasculitis and choroidal hypoperfusion. Systemic workup revealed no extrapulmonary involvement; however, interferon-gamma release assay was strongly positive. Following initiation of standard four-drug antitubercular therapy, adjunctive oral corticosteroids were administered, achieving complete resolution of intraocular inflammation and marked visual recovery, with no recurrence during long-term follow-up. This case highlights intralesional reactivation within chorioretinal atrophy as a distinctive imaging hallmark suggestive of tubercular etiology. Recognition of this pattern may facilitate earlier diagnosis of intraocular tuberculosis, particularly in endemic regions or in patients lacking overt systemic disease. Given the potential for irreversible vision loss, timely initiation of antitubercular therapy-guided by multimodal imaging and immunologic testing-is critical. Our findings underscore the need to consider ocular tuberculosis in the differential diagnosis of posterior uveitis, even in immunocompetent individuals with isolated ocular symptoms, and advocate for heightened awareness of this subtle yet pathognomonic feature to improve diagnostic precision and clinical outcomes.
Jing Chen (Mon,) studied this question.