The differential diagnosis includes HLA-B27–associated uveitis, idiopathic pars planitis, Behçet disease, Eales disease, sarcoidosis, tuberculosis, and syphilis. Appropriate history and laboratory evaluation help distinguish these entities from leptospiral uveitis. A definitive diagnosis requires isolation of the organism from bodily fluids. A presumptive diagnosis is made on the basis of serologic assays. Rapid serologic assays such as ELISA and complement-fixation tests for the detection of IgM antibodies against leptospiral antigens are highly sensitive and specific, and PCR-based assays are under evaluation. Leptospirosis may cause a false-positive result on RPR or FTA-ABS tests.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.