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D. Doycheva, C. Deuter, C. Pfannenberg, E. Schuelen, J. Hetzel, V. Kempf, M. Zierhut; PET/CT-Scan Confirms a Role of Tuberculosis in Serpiginous-Like Choroiditis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1528.
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While in India serpiginous-like choroiditis (SC) is very often induced by tuberculosis (TB), this association is not known for SC in the western world. Single studies showed a high incidence of positive interferon gamma release assay (IGRA) in patients with this form of uveitis. Limitation of IGRA is its inability to distinguish between active and latent TB. Using positron-emission tomography combined with computer tomography (PET/CT) as a sensitive diagnostic method, we investigated the role of TB in the pathogenesis of serpiginous-like choroiditis.
Seventeen patients with SC were screened by QuantiFERON TB-Gold test. Positive results were found in 13 patients (76%). FDG-PET/CT-scan was performed in all quantiferon positive patients.
The PET/CT-scan showed active lesions with elevated fluorodeoxyglucose (FDG)-uptake in mediastinal or hilar lymph nodes in 3 patients (23%). Inactive postspecific pulmonary lesions without FDG-uptake were found in 8 patients (62%). In two of the quantiferon positive patients the PET/CT-scan was negative (15%). In 6 patients with SC, showing a progressive and sight-threatening course and PET/CT lesions, a tuberculostatic and anti-inflammatory treatment was instituted. In all patients remission was observed, but in one patient a recurrence of the choroiditis occurred during the follow-up period.
Besides often positive QuantiFERON TB-Gold test and a treatment effect after anti-TB and anti-inflammatory therapy, the high incidence of postspecific PET/CT findings in patients with serpiginous-like choroiditis gives new evidence supporting the thesis, that TB may play a role in the pathogenesis of this uveitis form also in the western world.
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