Clinical manifestations of patients with intraocular inflammation and positive QuantiFERON-TB gold in-tube test in a country nonendemic for tuberculosis

Rina La Distia Nora, Mirjam E J van Velthoven, Ninette H Ten Dam-van Loon, Tom Missotten, Marleen Bakker, Martin P van Hagen, Aniki Rothova

Research output: Contribution to journalArticleResearchpeer-review

Abstract

PURPOSE: To evaluate clinical manifestations of patients with uveitis and scleritis of unknown origin and positive QuantiFERON-TB Gold In-Tube test (quantiferon) in a country not endemic for tuberculosis.

DESIGN: Multicenter retrospective cohort study.

METHODS: Retrospective review of the clinical, laboratory, and imaging data of 77 patients. Main outcome measures consisted of ocular and systemic features as well as results of laboratory examinations.

RESULTS: Out of all, 60 of 71 (85%) were living for at least 6 months in tuberculosis-endemic regions. Location of uveitis was variable; posterior uveitis (29/77; 38%) was the most frequent. Two clinical entities were commonly noted: retinal occlusive vasculitis (21/77; 27%) and serpiginoid choroiditis (11/77; 14%). Antituberculosis treatment was completed in 32 patients; 29 of them (91%) achieved complete remission. Mean quantiferon level was 7.5 U/mL; 71% had values above 2 U/mL and 41% above 10 U/mL. We observed no associations between quantiferon levels and clinical and/or imaging features. Previous tuberculosis infection was diagnosed in 5 of 77 patients (6.5%), while hilar/mediastinal lymphadenopathy was found in 25 of 76 patients (33%). Of these, 12 were consistent with the diagnosis of sarcoidosis, 9 were typical for (prior) tuberculosis, and 4 were compatible with both diagnoses.

CONCLUSIONS: Ocular features of patients with idiopathic uveitis and positive quantiferon were diverse, but retinal occlusive vasculitis and serpiginoid choroiditis were common. The quantiferon levels were usually highly elevated and 33% of patients exhibited lymphadenopathy, suggesting frequently the diagnosis of sarcoidosis. Ocular inflammation reacted favorably to antituberculosis treatment, although only a small minority had documented (prior) tuberculosis.

Original languageEnglish
Pages (from-to)754-61
Number of pages8
JournalAmerican Journal of Ophthalmology
Volume157
Issue number4
DOIs
Publication statusPublished - Apr 2014

Keywords

  • Adult
  • Antitubercular Agents/therapeutic use
  • Choroiditis/diagnosis
  • Endemic Diseases
  • Female
  • Humans
  • Interferon-gamma Release Tests
  • Male
  • Middle Aged
  • Netherlands/epidemiology
  • Retinal Vasculitis/diagnosis
  • Retrospective Studies
  • Scleritis/diagnosis
  • Tomography, X-Ray Computed
  • Tuberculin Test
  • Tuberculosis, Ocular/diagnosis
  • Uveitis/diagnosis
  • Visual Acuity

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