QuantiFERON TB-Gold--a new test strengthening long-suspected tuberculous involvement in serpiginous-like choroiditis.
OBJECTIVE
To obtain a diagnosis of tuberculosis in patients with a specific subset of uveitis, serpiginous-like choroiditis. This subset has been suspicious for tuberculous etiology in single case reports and old textbooks.


METHODS
Retrospective evaluation of a diagnostic test in a specific uveitis cohort.


METHODS
QuantiFERON is an approved, antigen-specific test that utilizes synthetic peptides representing Mycobacterium tuberculosis proteins. After incubation, interferon gamma secreted by T lymphocytes in response to these antigens is measured. We used the test in 21 of 26 patients identified from our database with serpiginous-like choroiditis. Rates of QuantiFERON positivity were compared to a group of healthy hospital employees (n = 208), another group of healthy hospital workers after tuberculosis contact (n = 117), and a group of randomly tested patients with other uveitis forms (n = 45).


RESULTS
Eleven of 21 serpiginous-like choroiditis patients (52%) were tested positive. The rate of QuantiFERON positivity in the healthy control groups was 8.7% and 0.9%, and 13% in the other uveitis subsets. Four of the QuantiFERON-positive serpiginous-like choroiditis patients were treated with standard anti-tuberculostatic therapy; three finished the course and improved. Seven patients are either stable without therapy (n = 4) or on low-dose prednisone (n = 3).


CONCLUSIONS
QuantiFERON testing revealed a high number of positive patients, which indicates a tuberculous etiology in this uveitis subset. Whether bacterial activity or secondary immunologic processes are causative remains a matter of speculation.
Mackensen
Friederike
F
Interdisciplinary Uveitis Center, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. friederike.mackensen@uveitiszentrum.de
Becker
Matthias D
MD
Wiehler
Ute
U
Max
Regina
R
Dalpke
Alexander
A
Zimmermann
Stefan
S
D000328:Adult; D000368:Aged; D002833:Choroiditis / Q000382:microbiology* / Q000473:pathology*; D015331:Cohort Studies; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011933:Reagent Kits, Diagnostic; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000378:metabolism; D014392:Tuberculosis, Ocular / Q000175:diagnosis* / Q000378:metabolism
D011933:Reagent Kits, Diagnostic; D007371:Interferon-gamma