Abstract

P 219

A role of tuberculosis in serpiginous choroiditis confirmed by 18F-FDG-PET/CT-scan

Deshka Doycheva1, Christoph Deuter1, Christina Pfannenberg2, Jürgen Hetzel3, Philip Aschoff2, Volkhard Kempf4, Manfred Zierhut1
1Department für Augenheilkunde, Universitätsklinikum Tübingen, Tübingen; 2Department für Radiologie, Universitätsklinikum Tübingen, Tübingen; 3Medizinische Klinik, Universitätsklinikum Tübingen, Tübingen; 4Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum Tübingen, Tübingen

Objective
While in India serpiginous choroiditis (SC) is thought to be induced by tuberculosis (TB), this association is not clear 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 tuberculosis. Using positron-emission tomography combined with computer tomography (18F-FDG-PET/CT) as a sensitive diagnostic method, we investigated the role of tuberculosis in the pathogenesis of serpiginous choroiditis.
Methods
Eighteen patients with SC were screened by QuantiFERON TB-Gold test. Positive results were found in 14 patients (78%). In 16 patients previous chest-X-ray or CT of the lung were negative. 18F-FDG-PET/CT-scan was additionally performed in 13 QuantiFERON-positive serpiginous patients.
Results
The 18F-FDG-PET/CT-scan showed active lesions with elevated fluorodeoxyglucose (FDG)-uptake in mediastinal or hilar lymph nodes in 3 patients (23%). Inactive postinflammatory lymph node lesions without FDG-uptake were found in 8 patients (62%). Only in two of the QuantiFERON-positive serpiginous patients the 18F-FDG-PET/CT-scan was negative (15%). In 7 patients with serpiginous choroiditis, 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.
Conclusions
Besides often positive QuantiFERON TB-Gold test and a treatment effect with anti-TB and anti-inflammatory therapy, the high incidence of post-tuberculosis PET/CT findings in patients with serpiginous choroiditis gives new evidence supporting the thesis, that tuberculosis may play a role in the pathogenesis of this uveitis form also in the western world.

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