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

Publication date: Jul 01, 2025

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. Case report. 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. 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.

Concepts Keywords
Cd4 Adult
Lymphadenopathy Biopsy
Mutton Humans
Polymerase Immunosuppression
Immunosuppressive Agents
Immunosuppressive Agents
interferon-gamma release assay
Interferon-gamma Release Tests
Male
Panuveitis
panuveitis
Sarcoidosis
sarcoidosis
Sarcoidosis, Pulmonary
tuberculosis
Vitreous Body

Semantics

Type Source Name
pathway REACTOME Release
disease IDO assay
disease MESH Panuveitis
disease MESH Tuberculosis
pathway KEGG Tuberculosis
disease MESH sarcoidosis
disease IDO country
disease MESH retinal vasculitis
disease MESH lymphadenopathy
disease MESH granulomas
disease IDO immunosuppression
disease MESH Pulmonary tuberculosis

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