Powers, Ross

Purpose: To report a rare case of multifocal chorioretinitis subsequent to intravesical Bacillus Calmette-Guerin therapy for bladder cancer. Methods: Case report. Results: A 74-year-old man presented with ill-defined visual changes in his right eye, along with constitutional symptoms such as low-grade fever, chills with rigors, night sweats, headache, dry cough, memory problems, and unintentional weight loss. These symptoms occurred 11 months after receiving intravesical Bacillus Calmette-Guerin treatment for bladder cancer. His visual acuity in the right eye was 20/30. Examination of his right eye revealed multiple yellow white chorioretinal lesions, and optical coherence tomography imaging showed focal involvement of the choroid and overlying neurosensory retina. Blood-based testing using next-generation sequencing for detection of microbial cell free DNA (Karius test) was positive for Mycobacterium tuberculosis complex. The patient was treated with 12 months of triple therapy consisting of isoniazid, rifampin, and ethambutol. The chorioretinal lesions showed complete regression to flat scars, with no evidence of recurrence 15 months after discontinuation of systemic treatment. Conclusion: Despite being rare, the possibility of mycobacterial chorioretinitis should be considered in patients with new-onset visual symptoms after intravesical Bacillus Calmette-Guerin treatment for bladder cancer.