How do you approach a patient who has anterior uveitis and is referred for evaluation of ocular TB with a positive Quantiferon gold (as part of their workup) in countries with low TB incidence?

How do you manage a patient with anterior uveitis and a positive Quantiferon gold test for TB in countries with low tuberculosis incidence?

• I often choose conventional anti-tuberculosis therapy with a four-drug regimen if characteristic eye findings are present, regardless of TB risk factors
• I prefer to treat latent TB with appropriate therapy if there are no TB risk factors and the uveitis is severe but not responding to immunosuppressive therapy
• If there are no TB risk factors, no systemic symptoms, and the patient is improving on topical steroids, I repeat the Quantiferon test to rule out false positives and consider latent TB treatment accordingly
• After ruling out TB risk factors and confirming no evidence of active TB elsewhere, I consult with the ophthalmologist and treat for TB infection if high-dose steroids are planned, even if the positive test might be false
• Other