Tuberculosis: An Underestimated Cause of Serpiginous Choroiditis?

Abstract

Purpose:: Serpiginous choroiditis (SC) is a rare, often bilateral disease with a progressive recurrent course that can lead to severe reduction in visual acuity. Immunosuppressive therapy is recommended. The etiology of SC is unknown.

Methods:: We analyzed our patients with SC regarding the clinical findings and course of the disease. Especially the results of tuberculin skin test (PPD) and the QuantiFERON TB-2G (QFT) test were evaluated.

Results:: A total of 12 patients out of 23 (mostly caucasian) patients with SC had positive results (PPD or QFT or both) for tuberculosis (TB) (52%). Eight showed a clinically sigificant PPD skin test (34%). So far blood samples for QFT analysis were obtained from 15 patients. Nine of them were QFT positive (60%), six were negative. Two patients had postspecific lesions in their chest radiography. None of the patients had extraocular signs of TB. According to the clinical picture, selected patients were treated with antituberculous therapy, partly in combination with systemic steroids. None of the treated patients had further progression of their disease to date.

Conclusions:: The high number of patients with a positive result for TB suggests that TB may be a common cause for a SC-like clinical picture. TB should be considered as a possible differential diagnosis in any patient presenting with the clinical picture of SC. QFT seems to be a useful test to diagnose TB in these patients. This is especially important regarding possible therapeutical consequences. The areactive clinical picture of SC contrasts the classical picture of ocular manifestation of TB. Therefore, we suspect an immunologic delayed-type hypersensitivity mechanism in the pathogenesis of TB-associated SC-like posterior uveitis.

Keywords: chorioretinitis • uveitis-clinical/animal model • inflammation