Tuberculosis; the cunning agent presented with endopericarditis-associated bilateral uveitis

Mycobacterium tuberculosis can spread the whole body and rarely involve the eye. We report a case with endophthalmitis in one eye and simultaneous retinal vasculitis in the fellow eye. Systemic work up led us to infective endopericarditis. The vitreous and pericardial fluid polymerase chain reactions (PCR) were positive for M. tuberculosis. We started the quadruple antituberculous treatment (isoniazid, ethambutol, pyrazinamide, and rifampin). After two weeks, we discontinued all the medications to resolve the drug-induced hepatitis. We restarted isoniazid and rifampin, but hepatitis recurred. Finally, we chose isoniazid/ethambutol combination for 18 months, and also administered short term systemic corticosteroid. His vision improved considerably with no recurrence of hepatitis or tuberculosis for 3 years after completion of treatment. Ocular tuberculosis can masquerade as other causes of intraocular inflammation, and a medical team consists of an ophthalmologist and an infectious disease specialist might be needed for the diagnosis and management.