RESUMEN
PURPOSE: To evaluate the use of BAL for the diagnosis of sarcoidosic uveitis. METHODS: Retrospective study of 109 consecutive patients with uveitis and minimum 2 signs of ocular sarcoidosis who had a BAL and chest imaging. BAL(+) was defined as an alveolar (a) lymphocytosis (L) aL > 15% with aCD4/CD8 > 3.5. Serum angiotensin converting enzyme (sACE), tuberculin skin test and gallium scan were tested in 83, 95 and 24 patients. RESULTS: BAL was + in 26.6% of patients (86.2% females, mean age 50.8y) with mean aL = 46.8% and mean aCD4/CD8 = 8.5 which significantly differed form BAL(-) patients: 62.5% females, p < 0.02, mean age 43.6y, p < 0.05, mean aL = 17.2%, p < 0.001 and mean aCD4/CD8 = 1.8, p < 0.001. BAL(+) patients had 31% of bilateral hilar adenopathy (BHL(+)), and 59.1% of elevated sACE which significantly differed form BAL(-) patients: 8.8%, p = < 0.01 and 14.8% p < 0.001. CONCLUSION: Our findings suggest that BAL have a high diagnostic value and might be a useful additional test for the diagnosis of sarcoidosic uveitis, even with normal chest imaging.
Asunto(s)
Líquido del Lavado Bronquioalveolar/citología , Lavado Broncoalveolar/métodos , Linfocitos/patología , Sarcoidosis/complicaciones , Uveítis/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Líquido del Lavado Bronquioalveolar/inmunología , Relación CD4-CD8 , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Linfocitos/inmunología , Masculino , Persona de Mediana Edad , Radiografía Torácica , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sarcoidosis/diagnóstico , Uveítis/etiologíaRESUMEN
Toxic reactions (uveitis, arthritis and leucopenia) of Rifabutin at normal doses should always be considered because of pharmacokinetic interactions with other drugs (e.g. the protease inhibitors). This case demonstrates that this kind of uveitis is clinically significant as the diagnosis of uveitis, particularly hypopyon uveitis, in an immunocompromised patient generally mandates extensive systemic diagnostic evaluation, as well as intensive ophthalmic and systemic monitoring and therapy.