Lymphocyte Immunophenotyping and CD4/CD8 Ratio in Cerebrospinal Fluid for the Diagnosis of Sarcoidosis-Related Uveitis

Romain Paule¹, Laure Denis¹, Nicolas Chapuis², Julien Rohmer¹, Jonathan London³, Clemence Bonnet⁴, Anthony Chauvin⁵, Luc Mouthon¹, Dominique Monnet⁴, Claire Le Jeunne¹, Antoine Brezin⁶ and Benjamin Terrier⁷, ¹National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, Internal medicine, France, Paris, France, ²Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, Biological Hematology, France, Paris, France, ³Internal Medecine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, ⁴Referral Center for Rare Ophthalmological Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, ophtalmology, France, Paris, France, ⁵Emergency Département, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Diderot, Paris, France, Paris, France, ⁶Ophtalmology, Referral Center for Rare Ophthalmological Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, ophtalmology, France, Paris, France, ⁷Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: sarcoidosis and uveitis

Session Information

Date: Tuesday, October 23, 2018

Title: Miscellaneous Rheumatic and Inflammatory Diseases Poster III: Sarcoid, Inflammatory Eye Disease, and Autoinflammatory Disease

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: The diagnostic workup of uveitis is a challenge due to the wide range of diagnoses and the lack of a well-codified diagnostic procedure. Underlying causes are multiple and include 3 major etiological frameworks, i.e. pure ophthalmological entities, infectious diseases, and inflammatory diseases such as sarcoidosis. However, one third of uveitis is considered of undetermined origin or idiopathic. Lumbar puncture with analysis of cerebrospinal fluid (CSF) can be included in the diagnostic workup of uveitis, especially in intermediate and/or posterior uveitis. This study aimed to assess the diagnostic interest of determination of CD4/CD8 ratio in CSF for the etiological diagnosis of intermediate and/or posterior uveitis.

Methods: We prospectively included, from May 2016 to March 2018, patients referred to our department for the diagnostic workup of intermediate and/or posterior uveitis and who underwent lumbar puncture. Patients had a complete ophthalmological examination as well as a clinical and paraclinical examination for diagnostic purposes, and lymphocyte immunophenotyping using Transfix® was also performed on CSF. Etiological diagnoses were established according to international diagnostic criteria, including IWOS criteria for sarcoidosis. Diagnoses were made in a blind manner of Transfix® results.

Results:

Fifty-two patients (men 44%, median age 50 years) were included. Features of uveitis were: anterior (60%), intermediate (58%), posterior (67%), and 19 (37%) had panuveitis. The diagnosis of defined, presumed or probable sarcoidosis was made in 29% of patients while 49% of cases remained of undetermined origin. Eleven patients had other diagnoses.

Lumbar puncture was considered contributive in 10 cases (19%). Increased CSF protein (>0.4 g/L) (median 0.68 g/L, range 0.22–1.96 g/L) and lymphocytic meningitis (median 76, range 45–83) were noted in 8 cases each, respectively.

The median CD4/CD8 ratio in CSF in patients with definite sarcoidosis, presumed sarcoidosis and in those with uveitis of undetermined origin were 4.50 (1.78-5.94), 4.57 (2.12-5.84) and 2.83 (0.9-8.01) (P=0.03), respectively.

ROC curve analysis showed that the CD4/CD8 ratio threshold with the best performance was >3.56 for the diagnostic of ocular sarcoidosis with a 66.7% sensitivity, a 76.9% specificity, a 62.6% positive predictive value and a 80% negative predictive value, and an area under the curve of 0.74 (0.56-0.92). A threshold of 1.73 had a 100% sensitivity but a poor specificity of 20%. By analogy with the cut-off used in bronchoalveolar lavage fluid, CD4/CD8 ratio >3.5 had a 66.7% sensitivity, a 73.1% specificity, a 58.8% positive predictive value and a 79.2% negative predictive value for the diagnostic of ocular sarcoidosis.

Conclusion: The determination of CD4/CD8 ratio in CSF can be useful in the etiological workup of patients with intermediate and/or posterior uveitis, since a CD4/CD8 ratio >3.5 in CSF is suggestive of ocular sarcoidosis. These findings need to be confirmed on a larger patient population.

Disclosure: R. Paule, None; L. Denis, None; N. Chapuis, None; J. Rohmer, None; J. London, None; C. Bonnet, None; A. Chauvin, None; L. Mouthon, None; D. Monnet, None; C. Le Jeunne, None; A. Brezin, None; B. Terrier, None.

To cite this abstract in AMA style:

Paule R, Denis L, Chapuis N, Rohmer J, London J, Bonnet C, Chauvin A, Mouthon L, Monnet D, Le Jeunne C, Brezin A, Terrier B. Lymphocyte Immunophenotyping and CD4/CD8 Ratio in Cerebrospinal Fluid for the Diagnosis of Sarcoidosis-Related Uveitis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/lymphocyte-immunophenotyping-and-cd4-cd8-ratio-in-cerebrospinal-fluid-for-the-diagnosis-of-sarcoidosis-related-uveitis/. Accessed .

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