Presumed tuberculosis-induced retinal vasculitis, diagnosed with positron emission tomography (18F-FDG-PET/CT), aspiration biopsy, and culture.

Abstract

PURPOSE:

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.

CONCLUSION:

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.

• Authors: Deshka Doycheva, Christina Pfannenberg, Juergen Hetzel, Christoph M E Deuter, Carlos Pavesio, Volkhard A J Kempf, Eva Schuelen, Philip Aschoff, Narsing Rao, Manfred Zierhut
• Journal: Ocular immunology and inflammation (Ocul Immunol Inflamm) Vol. 18 Issue 3 Pg. 194-9 (Jun 2010) ISSN: 1744-5078 [Electronic] England
• PMID: 20482398 (Publication Type: Case Reports, Journal Article)

Chemical References

• DNA, Bacterial
• Radiopharmaceuticals
• Fluorodeoxyglucose F18

Topics

• Adult
• Biopsy, Needle (methods)
• DNA, Bacterial (analysis)
• Diagnosis, Differential
• Fluorescein Angiography
• Fluorodeoxyglucose F18
• Fundus Oculi
• Humans
• Lymph Nodes (microbiology, pathology)
• Male
• Mediastinum
• Mycobacterium tuberculosis (genetics, isolation & purification)
• Polymerase Chain Reaction
• Positron-Emission Tomography (methods)
• Radiopharmaceuticals
• Retinal Vasculitis (diagnosis, microbiology)
• Tuberculosis, Ocular (diagnosis, microbiology)