The role of the TB T-spot test in patients with tubercular retinal vasculitis
Purpose: To report tuberculosis (TB) T-spot diagnosis and management of two cases of presumptive tubercular retinal vasculitis in Singapore.
Method: Retrospective case reports.
Results: Two patients were diagnosed with presumptive TB retinal vasculitis using clinical features, TB T-spot test and ancillary investigations. They were successfully treated with a combination therapy of oral steroids, anti-tuberculosis medications and pan retinal photocoagulation (PRP). Follow-up demonstrated resolution of symptoms and signs with no complications arising from anti-tuberculosis medications.
Conclusions: TB retinal vasculitis presents diagnostic and therapeutic challenges. Ocular TB diagnosis is often presumptive, as confirmatory evidence of organisms from the eye has low yield. The results of culture and Mantoux test require a long waiting period. TB T-spot provides rapid results with high sensitivity and specificity, thus holding promise as a diagnostic tool. Management of TB retinal vasculitis is multi-modal and multi-disciplinary requiring oral steroids and pan-retinal photocoagulation by the ophthalmologists and anti-tuberculosis medications by the Physicians.