Diagnostic and Management Challenges in Interferon-γ Release Assay-Positive Patient with Sarcoid Panuveitis from a Non-Endemic Tuberculosis Region

Abstract

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.

Keywords: Immunosuppression; interferon-gamma release assay; panuveitis; sarcoidosis; tuberculosis.