Bilateral granulomatous uveitis mimicking tuberculosis: an atypical ocular presentation of biopsy-proven disseminated histoplasmosis.

Ocular histoplasmosis typically presents as presumed ocular histoplasmosis syndrome, characterised by chorioretinal scars and peripapillary atrophy without intraocular inflammation. Active inflammatory presentations are exceedingly rare and may closely mimic tuberculosis in endemic regions, posing significant diagnostic challenges.We report a middle-aged immunocompetent male farmer who presented with acute bilateral visual loss, redness and floaters. Examination revealed bilateral granulomatous anterior uveitis with dense vitritis with mutton-fat keratic precipitates, dense vitritis and 4+ anterior chamber reaction. Systemic evaluation identified a laryngeal mass; histopathological examination confirmed disseminated Histoplasma capsulatum infection. QuantiFERON-TB Gold and HIV serology were negative. Itraconazole was initiated before systemic corticosteroids, with marked clinical improvement and visual recovery from 6/60 to 6/18 bilaterally within 1 week.This case underscores the importance of systemic evaluation, tissue diagnosis and appropriate antifungal cover preceding corticosteroid use in presumed histoplasma-associated granulomatous uveitis in endemic settings.