Clinical Manifestations of Patients with Intraocular Inflammation and Positive QuantiFERON–TB Gold In-Tube Test in a Country Non-endemic for Tuberculosis – Accepted Manuscript

Abstract: Purpose: To evaluate clinical manifestations of patients with uveitis and scleritis of unknown origin and positive QuantiFERON–TB test Gold In-Tube (quantiferon) in a country not endemic for tuberculosis.Design: Multicentre 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, 60/71 (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 (n=11/77, 14%). Anti-tuberculosis treatment was completed in 32 patients, 29 (91%) of them 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 5/77 (6.5%) patients, while hilar/mediastinal lymphadenopathy was found in 25/76 (33%) patients. 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 anti-tuberculosis treatment, although only a small minority had documented (prior) tuberculosis.