Mistaking infection for inflammation

Abstract

SummaryAmong the first steps in diagnosing any patient with uveitis is to identify infection. Common infections that may masquerade as autoimmune disease include herpes simplex virus, varicella zoster virus or cytomegalovirus (CMV) anterior uveitis, chronic post‐surgical endophthalmitis, endogenous endophthalmitis, acute retinal necrosis, CMV retinitis in immunocopme patients, syphilis, atypical toxoplasmosis and tuberculosis. Patient history and clinical exam can often make the diagnosis. The utility of diagnostic tests such as treponemal tests, quantiferon testing, Mantoux skin test, and toxoplasmosis serology will be covered. Case series of polymerase chain reaction (PCR) testing of anterior chamber and/or vitreous aspirate for anterior segment and posterior segment uveitis will be reviewed, with an emphasis on demonstrated clinical utility. More invasive biopsy such as vitreous biopsy via pars plana vitrectomy or chorioretinal biopsy may be necessary in some settings. Appropriate treatment and criteria for treating specific infections will be covered. Cases of polymicrobial infection will be reviewed as well. Emphasis will be placed on distinguishing infection from autoimmune disease.