To report a case presented as papillophlebitis with positive Mantoux test that respond clinically to anti-tuberculosis medications.

A 35-year-old lady presented with decreased vision in her right eye for one week. She did not report any significant systemic disease. Corrected VA was 20/80. Right RAPD was slightly positive. There was a mild anterior vitritis. Fundoscopy showed retinal hemorrhages, cotton wool spots, and venous engorgement and dilation in all quadrants as well as swollen optic disc. Clinical diagnosis was non-ischemic CRVO presenting as a papillophlebitis.

Systemic laboratory tests were all normal except for Mantoux test (PPD) which was positive, 18 mm induration and 2+ redness. Chest radiography was negative for lung tuberculosis. With the probable diagnosis of papillophlebitis secondary to tuberculosis, the patient received a course of anti-tuberculosis medications. Four weeks later, the inflammation subsided and vision improved to 20/30.

Here in, we report a rare case with PPD-positive ocular tuberculosis with no sign of a systemic infection presenting first as papillophlebitis. This report may emphasize the importance of systemic work-up in young patients with CRVO. Furthermore, although papillophlebitis is a relatively benign condition, the differential diagnoses include a number of sight-threatening and potentially life threatening disorders should be excluded.