Review of people with retinal vasculitis and positive QuantiFERON®-TB Gold test in an area nonendemic for tuberculosis

Int Ophthalmol. 2018 Dec;38(6):2389-2395. doi: 10.1007/s10792-017-0739-4. Epub 2017 Oct 13.

Abstract

Purpose: To assess the frequency of a positive QuantiFERON®-TB Gold test (quantiferon) among patients with retinal vasculitis in an area nonendemic for tuberculosis (TB); to review clinical characteristics and management of affected individuals.

Methods: Consecutive patients with retinal vasculitis and a positive quantiferon were retrospectively analyzed. Demographics, clinical data, laboratory, imaging findings, and therapy were evaluated.

Results: Among 49 patients with retinal vasculitis, 12 (24%) had a positive quantiferon. Median age was 37 years, there were five female patients. Five individuals (42%) had previously lived in a country endemic for TB. Retinal vasculitis was occlusive in six patients (50%). On chest imaging, pulmonary tuberculosis was suspected in one patient (8.3%). Treatment modalities included full antitubercular treatment (n = 1), isoniazid prophylaxis (n = 6), systemic corticosteroids (n = 8), and laser treatment (n = 5). After a median follow-up of 27.5 months, inflammation was inactive (n = 6) or recurrently present (n = 6). No patient lost ≥ 2 lines of best-corrected visual acuity during follow-up.

Conclusions: The quantiferon test is recommended in the evaluation of people with retinal vasculitis. Interpretation of a positive result can be challenging in a country nonendemic for TB. The majority of patients with quantiferon-positive retinal vasculitis were found to have latent TB.

Keywords: Quantiferon; Retinal vasculitis; Tbc-related ocular inflammation; Tuberculosis; Uveitis.

MeSH terms

  • Adolescent
  • Adult
  • Antitubercular Agents / therapeutic use
  • Child
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Interferon-gamma Release Tests*
  • Isoniazid / therapeutic use
  • Male
  • Middle Aged
  • Retinal Vasculitis / diagnosis*
  • Retinal Vasculitis / drug therapy
  • Retinal Vasculitis / physiopathology
  • Retrospective Studies
  • Tuberculosis, Ocular / diagnosis*
  • Tuberculosis, Ocular / drug therapy
  • Tuberculosis, Ocular / physiopathology
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / physiopathology
  • Uveitis / diagnosis
  • Uveitis / drug therapy
  • Uveitis / physiopathology
  • Visual Acuity / physiology
  • Young Adult

Substances

  • Antitubercular Agents
  • Glucocorticoids
  • Isoniazid