Presumed tuberculosis-induced retinal vasculitis, diagnosed with positron emission tomography (18F-FDG-PET/CT), aspiration biopsy, and culture.
OBJECTIVE
The diagnosis of tuberculosis as an etiological factor in patients with uveitis is difficult because of lack of specific diagnostic tests. The authors report 2 cases of occlusive retinal vasculitis, in which (18)F-FDG-PET/CT was helpful for the diagnosis of tuberculosis as a presumptive cause of intraocular inflammation.


METHODS
In 2 patients with severe occlusive retinal vasculitis and positive QuantiFERON TB-Gold test, (18)F-FDG-PET/CT, transbronchial needle-aspiration biopsy, and microbiological investigation were performed.


RESULTS
(18)F-FDG-PET/CT showed increased fluorodeoxyglucose uptake in some mediastinal and hilar lymph nodes. After needle-aspiration biopsy of PET-positive lymph nodes, M. tuberculosis was recovered in culture in both cases. Remission of uveitis was achieved only after a combination therapy with 3 anti-tubercular agents and systemic steroids.


CONCLUSIONS
The authors favor the use of (18)F-FDG-PET/CT in patients with sight-threatening intraocular inflammation and positive interferon-gamma release assay. Anti-tubercular therapy, together with anti-inflammatory treatment, may lead to a remission in such patients.
Doycheva
Deshka
D
Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany. deshka_doycheva@yahoo.com
Pfannenberg
Christina
C
Hetzel
Juergen
J
Deuter
Christoph M E
CM
Pavesio
Carlos
C
Kempf
Volkhard A J
VA
Schuelen
Eva
E
Aschoff
Philip
P
Rao
Narsing
N
Zierhut
Manfred
M
D000328:Adult; D001707:Biopsy, Needle / Q000379:methods*; D004269:DNA, Bacterial / Q000032:analysis; D003937:Diagnosis, Differential; D005451:Fluorescein Angiography; D019788:Fluorodeoxyglucose F18; D005654:Fundus Oculi; D006801:Humans; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008297:Male; D008482:Mediastinum; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D031300:Retinal Vasculitis / Q000175:diagnosis* / Q000382:microbiology; D014392:Tuberculosis, Ocular / Q000175:diagnosis* / Q000382:microbiology
D004269:DNA, Bacterial; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18