Kalpana Babu

Utility of QuantiFERON TB gold test in a south Indian patient population of ocular inflammation

Aim: To study the utility of interferon-γ release assays (QuantiFERON TB gold test) in a south Indian patient population of intraocular inflammation. Design: Evaluation of a diagnostic test- a pilot study from January 2007 to October 2008. Materials and Methods: QuantiFERON TB gold test was performed on the following groups of patients following an informed consent. Group A included healthy volunteers without any exposure to tuberculosis (TB) or past history of TB (n=22). Group B included patients with active systemic TB diagnosed by the demonstration of acid-fast bacilli or by the histopathology finding of caseation with granuloma formation from the sputum, lymph node, skin or intestinal biopsies (n=26). Group C included patients with uveitis of known etiologies other than intraocular TB without any history of exposure to active TB (n=21). Group D included patients with a diagnosis of presumed intraocular TB, who responded to antitubercular therapy by decreased or no recurrences following treatment and with a minimum of nine months follow-up following initiation of antitubercular therapy (n=39). Results: The sensitivity and specificity of the QuantiFERON TB gold test to pick up active systemic TB was 58% and 77% respectively. The sensitivity and specificity of the QuantiFERON TB gold test to pickup intraocular TB was 82% and 76% respectively. Conclusions: QuantiFERON TB gold test alone may not be specific for intraocular TB. The significance of this test in a case scenario needs to be interpreted with clinical presentation and other evidences for intraocular TB.

Bilateral retinitis following chikun- gunya fever.

A 35-year-old male with a history of chikungunya fever, presented with diminution of vision in the right eye of one-week duration. His best corrected visual acuity (BCVA) was counting fingers 2 meters and 20/20 (Snellens) in the right and left eyes respectively. A diagnosis of neuroretinitis was made in the right eye while left eye showed features of retinitis. ELISA (serum) and polymerase chain reaction (aqueous) were positive for herpes simplex virus. The lesions did not show any response to antiviral or steroid treatment and appeared to be self-limiting. At five months follow-up, lesions had resolved well with BCVA of 20/120 and 20/20 in the right and left eyes respectively.

Pigmented Malignant Medulloepithelioma of the Ciliary Body

Medulloepitheliomas are usually amelanotic. Pigmented medulloepitheliomas are unusual and only two cases have been reported. We report an additional case of pigmented malignant medulloepithelioma of the ciliary body with histopathologic correlation.

Chloroma of the orbit in a non-leukemic adult: A case report

Granulocytic sarcoma has been reported as an isolated lesion in non-leukemic patients. However, the majority of these subjects develop acute leukemia within a mean interval of 10.5 months from the time of diagnosis. We present a case of granulocytic sarcoma of the orbit in a non-leukemic patient who was treated with chemotherapy and is doing well after a 2-year period. Patients who do not develop leukemia have a better prognosis. Appropriate treatment is delayed in most cases because of a high rate of misdiagnosis.

Review of Results of QuantiFERON TB Gold Test in Presumed Ocular Tuberculosis in a South Indian Patient Population

Abstract Aim: To review the results of QuantiFERON TB gold (QFT-G) in our patient population of presumed ocular tuberculosis and the effect of antitubercular therapy (ATT) on the QFT-G result. Materials and methods: Retrospective review of 82 cases of presumed ocular tuberculosis with a successful response to ATT and 6 months follow-up post-ATT. Appropriate statistical analysis was done for associations between QFT-G and independent variables. Pre-ATT QFT-G values were also compared to the post-ATT value. Results: There were no statistically significant differences in the results of QFT-G with age (0.635), gender (0.096), history of oral steroids (0.171), or type of uveitis (0.664). There was a statistically significant association between a positive QFT-G and serpiginous-like choroiditis (0.048). The majority of our patients had positive QFT even after completion of ATT but with a significant drop in the mean values post ATT (0.010). Conclusions: Our study shows significant association of positive QFT with serpiginous-like choroiditis and persistent positivity even after completion of ATT in majority of cases in our population. There was, however, a drop in the mean values of QFT-G post-ATT.

In vivo confocal microscopy in different types of posterior polymorphous dystrophy.

Posterior polymorphous dystrophy is a rare corneal dystrophy, usually detected by chance. This case series describes the morphologic features in the three different types of posterior polymorphous dystrophy using confocal microscopy.

Sarcoidosis in tuberculosis-endemic regions: India

Sarcoidosis is a multisystem inflammatory disease of unknown etiology affecting multiple organs. Earlier reports suggested that sarcoidosis was a disease of the developed world. However, recent reports suggest that the disease is found in the developing countries as well. Clinical, radiological, and histopathological similarities with tuberculosis pose a great challenge in countries endemic for tuberculosis. Mantoux test, high resolution computed tomography, and transbronchial lymph node and lung biopsies are diagnostic modalities, which play an important role in the diagnosis of sarcoid. In this review, we look at the epidemiology of sarcoid in tuberculosis-endemic regions, the sarcoidosis-tuberculosis link, clinical profile, diagnostic modalities, dilemma in the diagnosis, and the treatment of this disease.

Predictors for tubercular uveitis: a comparison between biopsy-proven cases of tubercular and sarcoid uveitis.

Aim: To look for clinical parameters that will assist in making a diagnosis of tubercular or sarcoid uveitis in a South Indian patient population Methods: Retrospective, nonrandomized, comparative study of 51 patients with a diagnosis of biopsy-proven tuberculosis and sarcoidosis. These patients had a minimum of 1-year follow-up after initiating treatment for either disease. Multivariate logistic regression analysis was used to determine clinical predictors of tubercular uveitis. Results: The mean age group was 47.08 ± 11.19 years. There were 39 women and 12 men in the study. Multivariate logistic regression analysis shows likelihood of uveitis being tubercular in etiology using 3 variables: Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and a positive Mantoux test 76.6%. Conclusion: A combination of Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and positive Mantoux test may be used clinically to differentiate tubercular from sarcoid uveitis in our patient population.

Two Successive Ocular Malignancies in the Same Eye of a HIV-positive Patient: A Case Report

Purpose: To report 2 successive ocular malignancies in the same eye of a HIV-positive patient at different CD4 counts. Materials and methods: A 36-year-old retrovirus-positive male presented with no perception of light in the left eye of 1 month duration. CD4 counts were 44 cells/mm3. Ultrasonography showed an exudative retinal detachment. Retinal biopsy suggested an intraocular B-cell lymphoma for which he received radiotherapy and chemotherapy. He presented 3 years later with a growth in the left eye with CD4 counts of 360 cells/mm3. Results: Histopathology of enucleated eye showed a low-grade conjunctival squamous cell carcinoma. At 1-year follow-up, there is no mass in the anophthalmic socket. Conclusions: This case highlights the development of 2 ocular malignancies in the same eye of an HIV-positive patient, at different CD4 counts, allowing the authors to speculate on additional factors involved in the development of the second malignancy.

Clinical Profile of Isolated Viral Anterior Uveitis in a South Indian Patient Population

Abstract Aim: To analyze the clinic profile of polymerase chain reaction proven viral anterior uveitis in a south Indian patient population. Materials & Methods: Retrospective, nonrandomized study between January 2009 and July 2012. Results: Out of the 36 patients with polymerase chain reaction (PCR)-positive viral anterior uveitis, 24 patients had varicella zoster virus (VZV) anterior uveitis, 7 patients had HSV anterior uveitis, 3 patients had cytomegalovirus (CMV) anterior uveitis, and 2 patients had chikungunya virus related anterior uveitis. Corneal involvement was seen in 21 cases (58.33%). An altered iris pattern was seen in 14 cases (38.89%). Increase in intraocular pressure (IOP) at the time of inflammation was seen in 10 cases (27.78%). Reactivations were seen in 22 cases (61.11%). A comparison of herpes simplex virus (HSV)- and VZV-related anterior uveitis did not reveal any significant factors except for a previous history of herpes zoster in VZV-associated uveitis. Conclusion: We see isolated viral anterior uveitis related to HSV, VZV, CMV, and chikungunya viruses in our patient population. Corneal involvement, pigmented keratic precipitates, an abnormal iris pattern, increase in IOP, and reactivations are seen as a spectrum of viral anterior uveitis in our patient population as well.