PHOTO ESSAY Good visual outcome of tuberculous chorioretinitis after ART initiation in a HIV-infected patient Erik Schaftenaar • Christina Meenken • G. Seerp Baarsma • Georges M. G. M. Verjans • Remco P. H. Peters Received: 10 July 2014 / Accepted: 17 August 2014 Ó Springer Science+Business Media Dordrecht 2014 Abstract Mycobacterium tuberculosis infection is an important cause of sight-threatening chorioretinitis in HIV-infected individuals living in M. tuberculosis endemic areas. We present a case of tuberculous chorioretinitis in a HIV-infected man after recent initiation of antiretroviral therapy in rural South Africa, who had nearly complete resolution of clinical signs and symptoms after standard tuberculosis treat- ment. His presentation was most likely associated with immune reconstitution inflammatory syndrome. Keywords Mycobacterium tuberculosis Á Tuberculous chorioretinitis Á HIV Á Immune reconstitution inflammatory syndrome Á South Africa Introduction Ocular tuberculosis (TB), including tuberculous cho- rioretinitis, is an important and sight-threatening condition in human immunodeficiency virus (HIV)- infected individuals [1–3]. TB associated with immune reconstitution inflammatory syndrome (IRIS) after antiretroviral therapy (ART) initiation is a specific condition that is well documented for pulmonary disease, but not for ocular presentation. Case A 57-year-old HIV-infected man presented at the eye clinic of a hospital in rural South Africa. The patient complained of an acute loss of vision, ocular pain and photophobia of the left eye for 2 weeks without any other systemic complaints. Three months earlier, he had initiated ART at low CD4 count (135 cells/lL). He was successfully treated for pulmonary tuberculo- sis more than a decade ago. On examination, visual acuity in the left eye was only ‘hand motion’ and vision in the right eye was normal. Slit-lamp examination of the left eye showed mild anterior chamber inflammation without posterior synechiae. At fundoscopic examination, a chorioret- inal granuloma was observed in the superotemporal quadrant of the retina accompanied by papilledema, retinal vasculitis and minimal vitritis (binocular indirect ophthalmoscope score of 1) (Fig. 1a). There E. Schaftenaar Á G. S. Baarsma Rotterdam Eye Hospital, Rotterdam, The Netherlands E. Schaftenaar Á G. M. G. M. Verjans Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands E. Schaftenaar (&) Á R. P. H. Peters Anova Health Institute, Johannesburg and Tzaneen, South Africa e-mail: e.schaftenaar@gmail.com C. Meenken Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands 123 Int Ophthalmol DOI 10.1007/s10792-014-9997-6