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Invited Commentary
December 2017

Uveitis—The Tortured Tale of the Tubercle

Author Affiliations
  • 1Departments of Ophthalmology, Biological Structure, and Pathology, University of Washington School of Medicine, Seattle
JAMA Ophthalmol. 2017;135(12):1328-1329. doi:10.1001/jamaophthalmol.2017.3514

Tuberculous uveitis has been recognized for a long time (Antoine Maitre-Jan described the first case of iritis associated with tuberculosis [TB] in 1707), and much is understood about its mechanisms. Numerous pathology studies have demonstrated ocular presence of Mycobacterium tuberculosis in cases of uveitis; animal studies have demonstrated that intraocular or miliary M tuberculosis infection will cause uveitic disease. The range of uveitis associated with TB is broad and includes anterior, intermediate, posterior, and panuveitis (including some interesting variants such as serpiginoid uveitis, retinal vasculitis, and choroidal tubercles). While most patients with biopsy-proven tubercular uveitis will have positive tuberculin test results (either the tuberculin skin test or the more recent interferon γ release assays [IGRA] such as QuantiFERON Gold), most patients with tubercular uveitis will have no evidence of pulmonary or other systemic disease. Multidrug treatment of true tubercular uveitis (often with concomitant corticosteroids) will often definitively resolve the uveitis. Conversely, many patients with uveitis will have positive tuberculin test results, particularly in endemic areas: do these patients actually have tubercular uveitis, or do they have 2 independent conditions?