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M. Zierhut, C. Deuter, D. Doycheva, P. Aschoff, E. Schuelen, J. Hetzel, V. Kempf, C. Pfannenberg; Role of FDG-PET/CT Scan in the Diagnosis of Uveitis With Occclusive Retinal Vasculitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2862.
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To demonstrate a case of occlusive retinal vasculitis, in which FDG-PET/CT was helpful to detect the underlying disease.
We first saw a 43 year old African from Guinea in June 2006, who complained about pain in his left eye. The visual acuity was reduced to 10/16, the IOP 48 mmHg. Besides 2+ cells in the anterior chamber with posterior synechiae, the fundus had massive vessel occlusion with neovascularisation of the optic disc and peripheral ischemia. The investigation (chest-X-ray, CT of the lung, serology for HIV and syphilis) showed a heterocygote thalassemia (HT) besides an elevated ACE (34). While we thought that HT can not induce such a retinopathy we suggested sarcoidosis to be the underlying diagnosis. Despite systemic corticosteroids, lasercoagulation and intravitreal Avastin, the disease continued. Also the quantiferon-test was positive. For analysis of any lymphnode activity and detection of other inflammatory lesions caused by tuberculosis or sarcoidosis we performed a FDG-PET/CT.
The FDG-PET/CT detected elevated FDG-uptake in several mediastinal lymphnodes. After biopsy of one lymph node the PCR for TB was negative, the histology showed a non-necrotizing inflammation, which was diagnosed as sarcoidosis. After 5 weeks the culture for TB came out to be positive. An anti-tuberculosis treatment (4 drugs) was instituted.
FDG-PET/CT was helpful to establish the diagnosis of a tuberculosis associated uveitis, which was not found using other radiological methods. Interestingly the biopsy first showed a diagnosis of sarcoidosis, what may be an additional finding for the similarities between both disorders.
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