Case ReportPRESUMED TUBERCULOUS MULTIFOCAL RETINITIS IN PATIENTS UNDER TREATMENT WITH BIOLOGIC AGENTSArantes, Tiago E. MD*,†; Lima, Luiz H. MD‡; Bressanin, Gláucio L. MD§; Marques, Cláudia D. MD¶; Duarte, Ângela B. MD¶; Muccioli, Cristina MD‡ Author Information *Department of Ophthalmology, Fundação Altino Ventura, Recife, Brazil; †Department of Ophthalmology, Hospital de Olhos Sadalla Amin Ghanem, Joinville, Brazil; ‡Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; §Department of Ophthalmology, Hospital da Visão de Toledo, Toledo, Brazil; and ¶Department of Rheumatology, Federal University of Pernambuco, Recife, Brazil. Reprint requests: Luiz H. Lima, MD, Department of Ophthalmology, Federal University of Sao Paulo (UNIFESP), Rua Botucatu, 821, Vila Clementino, São Paulo, São Paulo, Brazil, 04023-062; e-mail: [email protected] None of the authors has any financial/conflicting interests to disclose. Retinal Cases & Brief Reports 15(1):p 56-61, Winter 2021. | DOI: 10.1097/ICB.0000000000000747 Buy Metrics AbstractIn Brief Purpose: To report unique retinal fundus lesions and treatment outcomes of intraocular tuberculosis in patients under anti–tumor necrosis factor treatment. Methods: Retrospective review of two patients with laboratorial evidence of tuberculosis who had bilateral ocular signs and symptoms not attributable to other diseases. Multimodal imaging was analyzed at the time of presentation and after the treatment initiation. The study patients underwent standard treatment for tuberculosis. Results: Clinical and laboratory findings were consistent with the diagnosis of presumed tuberculosis. Color fundus photograph revealed the presence of multifocal yellowish retinal spots in the study eyes. On fluorescein angiography, the retinal lesions seen on color fundus photograph showed early hypofluorescence with progressive staining of its edges. Occlusive vasculitis with peripheral nonperfusion was also observed in both cases. Spectral domain optical coherence tomography demonstrated increased reflectivity and thickness on the topography of retinitis lesions. After specific antibiotic treatment for tuberculosis, there was complete disappearance of the retinal lesions in all study eyes. Conclusion: We report two unique cases of bilateral presumed intraocular tuberculosis presenting as multifocal retinitis in patients under biologic agent treatment. Anti–tumor necrosis factor agents may be related to unusual fundus manifestations of tuberculosis. This is a unique report of intraocular tuberculosis presenting as bilateral multifocal retinitis in two patients under treatment with biologic agents.