Presumed Tuberculosis-induced Retinal Vasculitis, Diagnosed with Positron Emission Tomography (18F-FDG-PET/CT), Aspiration Biopsy, and Culture

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 18F-FDG-PET/CT was helpful for the diagnosis of tuberculosis as a presumptive cause...

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Bibliographic Details
Published in:Ocular immunology and inflammation 2010-06, Vol.18 (3), p.194-199
Main Authors: Doycheva, Deshka, Pfannenberg, Christina, Hetzel, Juergen, Deuter, Christoph M. E., Pavesio, Carlos, Kempf, Volkhard A. J., Schuelen, Eva, Aschoff, Philip, Rao, Narsing, Zierhut, Manfred
Format: Article
Language:English
Subjects:
Adult
Biopsy, Needle - methods
diagnosis
Diagnosis, Differential
DNA, Bacterial - analysis
Fluorescein Angiography
Fluorodeoxyglucose F18
Fundus Oculi
Humans
Lymph Nodes - microbiology
Lymph Nodes - pathology
Male
Mediastinum
Mycobacterium
Mycobacterium tuberculosis - genetics
Mycobacterium tuberculosis - isolation & purification
PET/CT
Polymerase Chain Reaction
Positron-Emission Tomography - methods
Radiopharmaceuticals
Retinal Vasculitis - diagnosis
Retinal Vasculitis - microbiology
tuberculosis
Tuberculosis, Ocular - diagnosis
Tuberculosis, Ocular - microbiology
uveitis
vasculitis
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Summary: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 18F-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, 18F-FDG-PET/CT, transbronchial needle-aspiration biopsy, and microbiological investigation were performed. Results: 18F-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 18F-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.
ISSN:0927-3948
1744-5078
DOI:10.3109/09273948.2010.483318