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Diagnostic and Management Challenges in Interferon-γ Release Assay-Positive Patient with Sarcoid Panuveitis from a
Matteo Belletti1, Zaid Zoumot2, Asia Mubashir3
1Department of Ophthalmology, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Purpose:
To report a case of biopsy-proven sarcoidosis in a patient with panuveitis and a positive interferon-gamma release assay (IGRA) from a non-endemic tuberculosis (TB) country.
Methods:
Case report.
Results:
A 26-year-old male from the United Arab Emirates (UAE) presented with granulomatous panuveitis characterized by mutton-fat keratic precipitates, anterior chamber and vitreous cells, and retinal vasculitis. Laboratory evaluation revealed positive IGRA, normal serum angiotensin-converting enzyme level, and chest imaging showing lung nodularity along with hilar lymphadenopathy. Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) identified non-caseating granulomas and an elevated CD4+/CD8+ ratio. Both vitreous biopsy and EBUS-TBNA tested negative for TB polymerase chain reaction, leading to a definitive diagnosis of sarcoidosis. The patient was successfully managed with systemic immunosuppression and achieved sustained quiescence.
Discussion:
Patients from non-endemic TB countries can present with a positive IGRA in the context of sarcoidosis. Invasive biopsy evaluation is crucial for establishing an accurate diagnosis and initiating appropriate treatment.
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