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Diagnostic value of lumbar puncture for the etiological assessment of uveitis: a retrospective cohort of 188 patients

  • Inflammatory Disorders
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Abstract

Aim

To assess the relevance of lumbar puncture (LP) for the etiological diagnosis of uveitis and to establish predictive factors associated with its contributory use.

Methods

We performed a retrospective study of patients with de novo uveitis who were referred to our tertiary hospital for etiological diagnosis of uveitis, between January 2003 and July 2018. We included patients who underwent a LP as part of the etiological assessment of uveitis. LP was considered as contributory if it led to the etiological diagnosis or to correct the initially suspected diagnosis.

Results

One hundred eighty eight of the 1211 patients referred for evaluation (16%) had an LP, among these patients, 93 (49.4%) had abnormal results including 69 (36.7%) patients with hypercellularity, 69 (36.7%) with hyperproteinorachia, and 28 (14.9%) with oligoclonal bands and/or increased IgG index. LP was considered as contributing to the diagnosis in only 31 (16.4%) cases, among which there were 10 (5.3%) contributions to the etiological diagnosis and 21 (11.2%) modifications in the diagnosis classification.

Multivariate analysis established that African ethnicity (p < 0.001), bilateral uveitis (p = 0.01), presence of macular edema or retinal serous detachment (p = 0.048), presence of retinal vasculitis (p < 0.001), presence of neurological signs or symptoms (p = 0.01), and contributing cerebral MRI (p < 0.001) were all significantly associated with a contributory LP. LP did not lead to any therapeutic modification.

Conclusion

LP direct contribution to the diagnosis was rare and most often detected non-specific abnormalities. LP should be performed only in cases of neurological clinical signs or symptoms, suspicion of multiple sclerosis, Vogt-Koyanagi-Harada, or syphilis.

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Abbreviations

ACE:

Angiotensin-converting enzyme

ASAS:

Assessment of Spondyloarthritis International Society

BAL:

Bronchoalveolar lavage (BAL)

CBC:

Complete blood cell count

CIS:

Clinical isolated syndrome

CT:

Computerized tomography

LP:

Lumbar puncture

MEWDS:

Multiple evanescent white dot syndrome

MRI:

Magnetic resonance imaging

MSGB:

Minor salivary gland biopsy

MS:

Multiple sclerosis

OCL:

Oculocerebral lymphoma

RIS:

Radiologically isolated syndrome

TPHA:

Treponema pallidum hemagglutinations assay

VDRL:

Veneral Disease Research Laboratory

VKH:

Vogt-Koyanagi-Harada

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Author notes

  1. A. Gavoille contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, F-69004, Lyon, France

    R. Bernier, A. Gavoille, Y. Jamilloux & Pascal Sève

  2. Department of Ophthalmology, Croix-Rousse Teaching Hospital, Hospices Civils de Lyon, , Lyon, France

    R. Bernier, N. Chirpaz, L. Kodjikian & T. Mathis

  3. UMR-CNRS 5510 Matéis, Villeurbanne, Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France

    L. Kodjikian

  4. Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France

    Pascal Sève

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Contributions

RB, PS, and AG were the principal investigators; they conceived and designed the study. NC and RB collected data. All authors interpreted the data and approved the manuscript. RB and AG drafted the manuscript. PS, TM, YJ, and LK reviewed the manuscript.

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Correspondence to Pascal Sève.

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This study received approval from the ethics committee of the French Society of Ophtalmology.

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Bernier, R., Gavoille, A., Chirpaz, N. et al. Diagnostic value of lumbar puncture for the etiological assessment of uveitis: a retrospective cohort of 188 patients. Graefes Arch Clin Exp Ophthalmol 260, 1651–1662 (2022). https://doi.org/10.1007/s00417-021-05514-4

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