Abstract
Introduction: Sarcoidosis is a chronic granulomatous disorder which affects almost all parts of the body. It is usually idiopathic. Ocular involvement is noted in 25%–60% of patients with systemic sarcoidosis. It is very essential to rule out ocular tuberculosis as both can have similar presentations. Case report: A 26 year old patient presented with blurring of vision in left eye for nine months at Mongar regional referral hospital. Previously he was treated with topical steroids and cycloplegics for anterior uveitis. There were no systemic symptoms like dry cough, fever, chest pain and loss of weight. He had anterior chamber inflammation with iris nodule, vitritis and disc edema in left eye.The right eye had minimal anterior chamber reaction with only subtle iris nodule. Posterior segment examination was normal in right eye. He underwent blood investigations, chest X ray and contrast enhanced computed tomography of chest(CECT). The blood reports were normal. The chest X ray showed radiopaque lesions at both hilar region and multiple tiny radiopaque lesions in both lung fields.CECT chest showed significant paratracheal lymph nodes.Lymph node biopsy was not attempted due to extreme location. Based on clinical presentations and investigation findings a diagnosis of Presumed ocular sarcoidosis was made by using the criteria based on Revised International Workshop on Ocular Sarcoidosis.The patient was treated effectively with oral steroids for six months. Currently he is on low maintenance dose of oral steroids. Conclusions: Ocular sarcoidosis is a potentially blinding condition if not treated on time. There should be high suspicion of ocular sarcoidosis if patient presents with bilateral granulomatous anterior uveitis with hilar lymphadenopathy.However it is crucial to exclude ocular tuberculosis as both are mimickers of chronic granulomatous uveitis.
Highlights
Sarcoidosis is a chronic granulomatous disorder which affects almost all parts of the body
Ultrasound B scan of left eye revealed moderate dot like hyper reflectivity in the vitreous cavity.The retina, choroid and optic nerve head were normal. With these findings a diagnosis of right eye chronic anterior uveitis and left eye pan uveitis was made with a possible etiologies as tuberculosis, sarcoidosis or idiopathic.The report of complete blood count, liver function test, renal function test and random blood glucose were normal
The viral markers were unremarkable and serum calcium was normal (9.6 mg/dl).The chest X-ray showed bilateral hilar shadows with military opacities in both lung field.CECT chest revealed scattered bilateral miliary pulmonary nodules predominantly in upper lobes with mediastinal lymphadenopathy, largest nodule measuring 1.6cm in right paratracheal region.The ultrasound of abdomen was normal. With these clinical presentations,blood investigations,chest X ray and CECT, a diagnosis of presumed ocular sarcoidosis was made.The opinion on possibility of right paratracheal lymph node biopsy was sought from interventional radiologist
Summary
Sarcoidosis is a chronic granulomatous disorder which affects almost all parts of the body. Ultrasound B scan of left eye revealed moderate dot like hyper reflectivity in the vitreous cavity.The retina, choroid and optic nerve head were normal With these findings a diagnosis of right eye chronic anterior uveitis and left eye pan uveitis was made with a possible etiologies as tuberculosis, sarcoidosis or idiopathic.The report of complete blood count, liver function test, renal function test and random blood glucose were normal. The viral markers were unremarkable and serum calcium was normal (9.6 mg/dl).The chest X-ray showed bilateral hilar shadows with military opacities in both lung field.CECT chest revealed scattered bilateral miliary pulmonary nodules predominantly in upper lobes with mediastinal lymphadenopathy, largest nodule measuring 1.6cm in right paratracheal region.The ultrasound of abdomen was normal With these clinical presentations,blood investigations,chest X ray and CECT, a diagnosis of presumed ocular sarcoidosis was made.The opinion on possibility of right paratracheal lymph node biopsy was sought from interventional radiologist. The patient is on low dose oral steroids 2.5 mg every alternate day
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