Interest of QuantiFERON®-TB (QT) Gold test (Cellestis) in patients with positive Tuberculin Skin Test (TST) in etiologic and therapeutic work-up in uveitis

Purpose Define the interest of QuantiFERON®-TB Gold test (Cellestis) in patients with positive Tuberculin Skin Test (TST) to improve etiologic and therapeutic work-up in uveitis. Methods All patients followed in the Ophthalmology Department of Bicetre Hospital between April 2007 and March 2009 for uveitis had an extensive work-up including Tuberculin Skin Test (TST). Among them, 14 patients had a very positive TST making suspect an active tuberculosis infection. Then all of these patients had systematically a quantiFERON®-TB Gold test. Finally, charts from clinical exam and therapeutic management were retrospectively analysed. Results The mean age at the time of presentation was 58 years (+/- 9) and sex ratio (F/M) was 43%. Uveitis was bilateral in 43% of cases, and the location of inflammation was anterior in 43% of the cases, intermediate (21.4%), posterior (21.4%) or total (7%). The average of PPD test was 21.75mm (+/- 4mm, 15-65mm) and minimal delay between PPD and quantiFERON®-TB Gold test was 3 days (mean: 42 days +/- 17). QuantiFERON®-TB Gold test was positive in 9 patients (64.3%) enjoining introduction of a full anti-tuberculosis therapeutic treatment in 8 patients (57.1%), that preceded oral steroids regimen in 42.8% of cases. Visual acuity increased dramatically (6 lines) in 4 patients and was unmodified for the others. Conclusion QuantiFERON®-TB Gold test seems usefull in systematic diagnostic strategy in uveitis; it stays negative in 35.7% of the case suggesting that positive results are significant. However, further studies are necessary to define its place in diagnostic procedure in uveitis.