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

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.