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Use of pulmonary interferon γ responses to mycobacterial antigen to distinguish sarcoid associated optic neuropathy from tuberculosis
  1. B J L Burton1,
  2. R A M Breen2,
  3. G Janossy2,
  4. J F Acheson3,
  5. M C I Lipman4
  1. 1Department of Neuro-ophthalmology, Moorfields Eye Hospital, London EC1V 2PD, UK
  2. 2Department of Respiratory Medicine, Royal Free Hospital, London NW3 2QG, UK
  3. 3Department of Neuro-ophthalmology, Moorfields Eye Hospital, London EC1V 2PD, UK
  4. 4Department of Respiratory Medicine, Royal Free Hospital, London NW3 2QG, UK
  1. Correspondence to: MrBen Burton Department of Neuro-ophthalmology, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK; bjlburton{at}yahoo.co.uk

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The clinical distinction between sarcoidosis and tuberculosis (TB) can be difficult.1 Abnormal CD4 T cell function, demonstrated as cell mediated hyporesponsiveness (anergy), is considered to be a feature of sarcoidosis.2 Here we report the use of a sensitive assessment of mycobacterial specific CD4 T cell response to assist in the diagnosis of sarcoid associated optic neuropathy in a subject at high risk of TB.

Case report

A 53 year old Asian-Indian woman was referred with a 2 month history of intermittent blurred vision in her right eye and right optic disc swelling. She developed right eye ache and her vision deteriorated over 3 days to counting fingers in this eye. She also complained of malaise and night sweats though her weight was stable. She had recently returned to the United Kingdom after living in Uganda. Examination revealed a right afferent pupillary defect, chronically swollen right …

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