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J. H. Chow, P. S. Mettu, S. K. Srivastava, G. J. Jaffe; PPD and Positive Skin Test Controls in the Evaluation of Anergy in Uveitis Patients. Invest. Ophthalmol. Vis. Sci. 2008;49(13):799.
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To evaluate the PPD and positive control (mumps and candida) skin test positivity rates in patients with intraocular inflammation and to compare the rates between patients with sarcoidosis, a condition that predisposes to cutaneous delayed-type hypersensitivity anergy, and patients with non-sarcoid uveitic diagnoses.
Charts of patients with initial visits to the Duke University Eye Center between 1993 and 2007 were retrospectively reviewed. The rate of PPD and control skin test (mumps and candida) positivity, patient ethnicity, age, gender, and diagnosis were recorded. Skin test results for patients with a primary diagnosis of sarcoidosis, established by a combination of chest radiograph findings, biopsy results, and angiotensin-converting enzyme levels, were compared with results from all other uveitic diagnoses.
Of 294 patients presenting for evaluation and management of uveitis, sixty three (21.4%) were diagnosed with sarcoidosis. Out of these patients, three (4.8%) had a positive PPD test, while sixty one (95.3%), had negative PPDs. None of the sarcoid patients with positive PPDs had positive skin tests for mumps or candida (positive controls). Of the sixty one sarcoid patients with negative PPDs, fourteen (23.0%) had positive skin tests for mumps, while thirteen (21.3%) had positive skin tests for candida. The overall rate of mumps skin test positivity in non-sarcoid patients was 70.8%, compared to a positivity rate of 35.0% in sarcoid patients (p<0.0001). The rate of candida skin test positivity in non-sarcoid patients was 64.5%, compared to a positivity rate of 35.1% in non-sarcoid patients (p < 0.005). Of those patients with negative PPDs, 69.5% of non-sarcoid patients 35.9% of sarcoid patients had positive mumps skin tests, a significant difference (p<0.001). Similarly, 63.5% of non-sarcoid patients and 36.1% of sarcoid patients with negative PPDs were positive for candida (p< 0.01).
The rates of positivity of skin test controls, mumps and candida, were significantly higher in patients with non-sarcoid uveitis compared to sarcoid patients in PPD-negative patients. These skin tests may be a useful adjunct to the diagnosis of uveitic sarcoidosis, a condition that predisposes to delayed-type hypersensitivity anergy.
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