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Comparison of uveitis manifestations in patients with active systemic tuberculosis and those with positive interferon-gamma release assay without active disease

Eye volume 39, pages 1772–1780 (2025)Cite this article

Subjects

Abstract

Objective

To evaluate the clinical manifestations of uveitis in patients with active systemic tuberculosis (TB) and compare them to those with uveitis of undetermined cause who were positive for the interferon-gamma release assay (IGRA) but did not have active systemic TB.

Methods

This retrospective study included 118 patients: 51 with uveitis and active systemic TB, 52 with undetermined cause of uveitis and positive IGRA but no active systemic TB, and 15 with positive Mycobacterium tuberculosis (Mtb) polymerase chain reaction (PCR) results from ocular fluids but no active systemic TB. Demographic data, ocular findings, and systemic TB investigations were analysed and compared.

Results

Patients with evidence of active TB were predominantly younger. Typical manifestations of ocular TB (OTB) were more frequently observed in patients with active systemic TB (p < 0.001) and were significantly associated with younger age (p = 0.002). In patients without active systemic TB but positive Mtb PCR from ocular fluid, ocular manifestations closely resembled those of patients with active systemic TB, particularly with respect to the presence of choroidal granulomas. In contrast, patients with an undetermined cause of uveitis who tested positive for IGRA were older, and their clinical features were more often atypical.

Conclusions

Uveitis associated with active systemic TB was characterised by typical OTB manifestations and occurred more frequently in younger patients. These findings highlight the importance of considering TB in the differential diagnosis of uveitis, especially in younger individuals, and suggest that atypical manifestations may be more common in older patients and in patients without active TB.

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Fig. 1: Typical ocular manifestations of ocular tuberculosis according to the Standardised Uveitis Nomenclature (SUN working group) classification.
Fig. 2: Representative images of atypical ocular manifestation in our ocular tuberculosis cohort.

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Data availability

The data presented in this study are available upon specific request to the corresponding authors.

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Acknowledgements

We thank Priscilla Jessica, MD, Rachel Ethelind, MD, and Erica Widodo, MD for their assistance in collecting and organizing the medical records database. We also thank Prof. Ratna Sitompul, MD, Ph.D., Lukman Edward, MD, Ph.D, Made Susiyanti, MD, Ph.D, Yulia Aziza, MD, Ph.D., and the residents for their contributions to patient management in the clinic.

Funding

IP is supported by Indonesia Endowment Fund for Education (Lembaga Pengelola Dana Pendidikan – LPDP, No: 0004535/MED/D/19/lpdp2021). The funding source had no involvement in the collection, analysis, interpretation, writing of the report, and the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia

    Ikhwanuliman Putera & Rina La Distia Nora

  2. Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, the Netherlands

    Ikhwanuliman Putera & Aniki Rothova

  3. Department of Internal Medicine Section Allergy and Clinical Immunology, Erasmus University Medical Centre, Rotterdam, the Netherlands

    Ikhwanuliman Putera & Rina La Distia Nora

  4. Laboratory Immunology, Department of Immunology, Erasmus University Medical Centre, Rotterdam, the Netherlands

    Ikhwanuliman Putera

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Contributions

IP: Data acquisition, data analysis, manuscript drafting, approval of the final manuscript. AR: Design, data analysis, review and editing, approval of the final manuscript. Supervision. RLDN: Data acquisition, data analysis, review and editing, approval of the final manuscript, supervision.

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Correspondence to Rina La Distia Nora.

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Putera, I., Rothova, A. & La Distia Nora, R. Comparison of uveitis manifestations in patients with active systemic tuberculosis and those with positive interferon-gamma release assay without active disease. Eye 39, 1772–1780 (2025). https://doi.org/10.1038/s41433-025-03751-z

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