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ARTICLE TYPE : CASE REPORT

Published on :   15 Dec 2025, Volume - 1
Journal Title :   WebLog Journal of Ophthalmology and Visual Sciences | WebLog J Ophthalmol Vis Sci
Source URL:   weblog iconhttps://weblogoa.com/articles/wjovs.2025.l1502
Permanent Identifier (DOI) :  doi iconhttps://doi.org/10.5281/zenodo.18027481

Cytomegalovirus Anterior Uveitis Masquerading as Ocular Tuberculosis: A Diagnostic Challenge in an Immigrant Patient with Latent Tuberculosis

Luke M. Nelson 1
Kira Yates 1
Armando Ugarte 1
Katrina Chin Loy 1
Miriam Michael 2
Brian K. Do 3,4
Siham Mahgoub 5 *
1Department of Ophthalmology, Howard University Hospital, Washington, DC, USA
2Department of Internal Medicine, Howard University Hospital, Washington, DC, USA
3The Retina Group of Washington, Chevy Chase Office, MD 20815, Maryland, USA
4Georgetown University School of Medicine, Washington, DC, USA
5Division of Infectious Diseases, Howard University Hospital, Washington, DC, USA

Abstract

Purpose: To describe a case of cytomegalovirus (CMV) anterior uveitis misdiagnosed as presumed ocular tuberculosis (TB) in an immunocompetent immigrant patient, leading to delayed diagnosis, corneal graft failure, and eventual vision loss.

Observations: A 74-year-old Filipino male with recurrent unilateral hypertensive anterior uveitis and a positive QuantiFERON-TB Gold test was treated for presumed ocular TB with RIPE therapy. Despite treatment, inflammation persisted, leading to corneal decompensation and a need for endothelial keratoplasty. The graft ultimately failed, and aqueous humor polymerase chain reaction (PCR) testing subsequently revealed CMV DNA. Antiviral therapy was initiated, and a subsequent penetrating keratoplasty was successful.

Conclusions and Importance: This case highlights the diagnostic pitfalls of anchoring bias in uveitis workups, particularly in TB-endemic or immigrant populations. CMV should be considered in unilateral hypertensive anterior uveitis, even in immunocompetent hosts. Aqueous PCR testing is critical in refractory cases to prevent irreversible vision loss.

Keywords: Uveitis; Cytomegalovirus; Tuberculosis; Diagnosis; Anterior; Masquerade

Citation

Nelson LM, Yates K, Ugarte A, Loy KC, Michael M, Do BK, et al. Cytomegalovirus Anterior Uveitis Masquerading as Ocular Tuberculosis: A Diagnostic Challenge in an Immigrant Patient with Latent Tuberculosis. WebLog J Ophthalmol Vis Sci. wjovs.2025.l1502. https://doi.org/10.5281/zenodo.18027481
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