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Maite Sainz de la Maza, Victor Llorens, Marina Mesquida, Laura Pelegrin, Alfredo Adan Civera; Presumed Tuberculosis-Related Scleritis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5286.
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To evaluate clinical features of patients with scleritis of unknown origin and positive QuantiFERON-TB Gold test (quantiferon)
Retrospective review of clinical, laboratory, and therapeutic outcome data of 12 patients with scleritis and positive quantiferon. Quantiferon was ordered in patients with clinically suspected tuberculosis-related scleritis after past and family histories and review of system questionnaires. Other possible etiologies were ruled out
Scleritis patients with positive quantiferon were 7 men and 5 women with a mean age of 49.5 years (range, 33 to 74 years). Nine patients were Spanish-born and 3 patients were foreign-born (endemic countries). Scleritis was diffuse in 8 patients and nodular in 4 patients. It was bilateral in 7 patients (58%) and recurrent in 12 patients (100%). Scleritis appeared after some time of presumed tuberculosis-related uveitis (mean, 73 months; range, 2-336 months) in 6 patients (3 anterior uveitis, 2 panuveitis, and 1 retinal vasculitis) and concomitantly with peripheral keratitis in 4 patients. Previous ocular surgery was found in 5 patients (3 cataract extractions and 2 pars plana vitrectomies): mean period between surgery and scleritis onset was 18 months (range, 3 to 28 months). Mean quantiferon level was 9.5 IU/ml; 58% had values above 2 U/ml and 17% above 10 U/ml. Tuberculosis skin test was positive in all but one patient. There was no association between quantiferon levels and specific ocular features (p=0.1). Previous extra-ocular tuberculosis infection was diagnosed in 5 patients (42%) and previous tuberculosis contact was detected in 3 patients (25%). Chest X-ray showed old findings of pulmonary tuberculosis infection in 3 patients (25%). Antituberculosis treatment (3 drugs for 4 months followed by 2 drugs for 2 months) was completed in 9 patients; eight (89%) of them achieved complete remission and 1 partial remission
Presumed tuberculosis-related scleritis may appear in recurrent scleritis of unknown origin and positive quantiferon. It may sometimes occur after a period of presumed tuberculosis-related uveitis and/or concomitantly with peripheral keratitis, and may be triggered by previous ocular surgery. There was no association between quantiferon levels and specific ocular features. No patients had evidence of active infection in chest X-ray and only few had previous extra-ocular tuberculosis. An adequate antituberculosis treatment leads to a favorable prognosis
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