Serpiginous choroiditis revisited

Abstract Purpose Serpiginous Choroiditis (SC) is a subtype of posterior uveitis with often unfavorable visual prognosis, often requiring intensive immunosuppressive treatment. Histological and clinical evidence has been reported linking tuberculosis to cases of chorioiditis and specifically to serpiginous‐like chorioiditis . A potential tuberculous origin is of concern as the treatment would be completely different. Tuberculin skin test has limited power for diagnosing tuberculosis since active disease cannot be differentiated from immunity and because of cross‐reactivity with bacillus Calmette‐Guérin (BCG). It is one of the oldest diagnostic tests still in use worldwide with variable sensitivity and specificity depending on the cut‐off used and the population screened.Therefore, we used an interferon‐γ release assay (QuantiFERON TB‐Gold; Cellestis, Australia) to obtain a diagnosis of tuberculosis in patients with serpiginous like chorioditis. Methods Quantiferon is an approved, antigen‐specific test that utilizes synthetic peptides representing M. tuberculosis proteins. After incubation, interferon‐γ secreted by T‐lymphocytes in response to these antigens is measured. Results In our cohort 52 % of SC patients were tested positive. Patients with SC also showed higher absolute Tb antigen responses as compared to Quantiferon positive patients with other uveitis subtypes. Conclusion Our findings support a tuberculous origin in SC. Other groups also found evidence of Tb association with SC, proven by radiologic imaging. These patients seem to improve with anti‐Tb treatment. The diagnostic significance of Quantiferon and other Tb testing in patients with SC and treatment implications will be discussed.