Drei Fälle - eine Diagnose: okuläre Manifestationsformen der Sarkoidose

Abstract

Sarcoidosis can manifest itself in a variety of affection patterns in the eye. Early diagnosis and treatment are of crucial importance. Therefore the following three cases present occular symptoms associated with sarcoidosis. Three case reports are described. We report three cases with panuveitis but different anamneses. A 14-year-old boy suffered initially from a medically refractory sinusitis, followed by panuveitis with a distinct pattern of chorioretinal involvement. Furthermore, there was a facial palsy, swelling of the parotid glands, fever, and a deterioration of his general condition. The histological examination of a turbinectomy revealed a granulomatous inflammation with non-caseating granulomas. The second patient, a 66-year-old female, presented with the suspected diagnosis of paraneoplastic syndrome and positive anamnesis for sigma carcinoma. One of her main symptoms was significant uveitis with a pronounced inflammation in the anterior chamber. The suspicious lesions in thoracic CT yielded to the diagnosis of sarcoidosis. The third patient, a 51-year-old male, seemed to be generally healthy. He described a loss of visual acuity, which was explained by vitritis and a pronounced macular oedema. As part of the search for underlying diseases the chest radiography showed abnormal structures. In all patients the diagnosis was sarcoidosis. Moreover, in the first case Heerfordt syndrome, a special form of sarcoidosis, was diagnosed. In all three patients a significant improvement of visual acuity occurred under systemic prednisolone therapy. These cases demonstrate the broad spectrum of manifestations of sarcoidosis in ophthalmology. Moreover, the early diagnosis and implementation of therapy were decisive for the prognosis.