Purtscher-like retinopathy as a first presentation of systematic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease, characterized by the involvement of multiple organ systems. Ocular involvement, being one of the manifestations, contributes to the assessment of disease activity. Purtscher-like retinopathy has been reported as a manifestation of SLE. An otherwise healthy 21-year old female presented with a bilateral rapid decrease in vision for 1 month. Fundus examination revealed multiple cotton wool spots and flame-shaped hemorrhages in both eyes. Optical coherence tomography displayed bilateral severe macular edema. Fundus fluorescein angiography showed multiple retinal arteriolar occlusions. A rheumatologist was consulted for investigation. Based on the American College of Rheumatology 1982 Revised Criteria for diagnosing SLE, a diagnosis of SLE was made. She was subsequently treated with corticosteroids and immunosuppressive medication. Although vaso-occlusive retinopathy is a rare presentation of SLE, it is significant in diagnosing SLE in a patient, to promptly initiate proper treatment.

The use of Quantiferon-TB gold in-tube test in screening latent tuberculosis among Saudi Arabia dialysis patients.

BACKGROUND AND AIM: Screening for tuberculosis (TB) is a key strategy for controlling infection. This study aimed to detect latent TB among dialysis patients. METHODS: This is a prospective study conducted in King Saud University, Riyadh involving hemodialysis (HD) and peritoneal dialysis (PD) patients aged ≥18 years. Patients were screened for latent TB infection (LTBI) using both TBskin test (TST) and QuantiFERONTB Gold In-Tube test (QFT-GIT). All participants were followed-up clinically and radiologically every 3 months for 2 years. RESULTS: A total of 243 (181 HD and 62 PD) patients were included and 112(46.1%) were males. 45.3% showed positive QFT in HD patients with sensitivity of 91.7%, specificity of 71.4%, positive predictive value (PPV) of 19.5%, and negative predictive value (NPV) of 91.1%. TST results in HD showed that positive TST was 17.4%, sensitivity was 63.2%, specificity was 95.5%, PPV was 51.5%, and NPV was 91.1%. Five (8.1%) showed positive QFT in PD patients with sensitivity of 7.7%, specificity of 91.8%, PPV of 6.6%, and NPV of 92.3%. TST results in PD showed that positive TST was 9.8%, sensitivity was 35.7%, specificity was 97.9%, PPV was 55.8%, and NPV was 93.3%. Previous TB infection was significantly correlated with QFT only in HD patients, but significantly associated with TST in both HD and PD patients. Also in HD, QFT was significantly associated with TST (P = 0.043). CONCLUSIONS: Due to high variability of QFT-GIT sensitivity, we recommend its use for its NPV and to use either TST or QFT in screening latent TB.