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Robert G. Josephberg, Daniel Husney, Chelsea Lafebvre; PPD Negative Quantiferon Negative Biopsy Proven Tuberculous Retinal Vasculitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2759.
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To present athe first case of PPD negative, Quantiferon negative,and Biopsy proven Tuberculousis causing retinal vasculitis
Case Report of a 26 year old male that presented to the WestchesterMedical Center Emergency Room with progressive, painless visualloss. Visual Acuity in the affected eye was CF at 1 foot whilethe other eye was 20/20. Retinal exam was significant for aRetinal heme, tortuous vessels, 'Macular Star' formation andscattered cotton wool spots.
The patient was admitted and given Intravenous steroids forpresumed Vasculitis. Systemic workup ensued, including Hypercoaguableworkup, Echocardiogram, MRI of the Brain and Orbits, along withInfectious Disease workup which included a Lyme test and Bartonellatiters. Rhuematologic workup was also negative. Chest radiographwas performed which showed a suspicion of a Right upper lobeopacity. The patient was put in isolation, and sputum for AcidFast Bacilli were collected and a PPD was placed. The PPD wasnegative and a quantiferon test was performed which was negativeas well. A pulmonology consult was placed and the decision toundergo biopsy was made. The biopsy of the lung lesion ultimatelygrew up pan sensitive Mycobaterium Tuberculosis.
The delay in diagnosis of Tuberculosis infection presented aa major health risk to all the healthcare professionals thatencountered this patient. Mycobacterium Tuberculosis shouldbe considered in patients presenting with retinal vasculitisand it can not be ruled out despite negative serologic markers,the newest being the Quantiferon test (98% sensitivity)
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