Weight loss with fever an...

A 35-year-old man from China presented with a 1-month history of night sweats, weight loss, fever, abdominal bloating, and progressive left eye vision loss. He had started infliximab 3 months prior for Crohn’s disease. Physical examination revealed mild hepatomegaly and a left eye visual field defect over the superior nasal quadrant. Fundoscopy demonstrated a choroidal tuberculoma with retinal detachment (Figure 1). Abdominal computed tomography revealed multiple hepatic and splenic hypodensities (Figure 2). Biopsy of the choroidal mass demonstrated caseating granulomas with acid-fast bacilli, and cultures growing Mycobacterium tuberculosis. HIV testing was negative. Infliximab was stopped.