Abstract
We report a case of ocular sarcoidosis with positive immunoglobulin (Ig) M and IgG serology for toxoplasmosis. The patient was a young female with red painful eyes, bilateral eyelid edema, and panuveitis with periphlebitis. In laboratory testing, she was IgM and IgG positive for toxoplasmosis and anergic in the tuberculin test. Topical treatment for anterior uveitis and oral antibiotics for toxoplasmosis were started, without improvement. Orbit tomography showed increased lacrimal glands bilaterally, and chest X-ray radiographic findings were consistent with pulmonary sarcoidosis, which supported the presumed ocular sarcoidosis diagnosis. The patient was treated with oral prednisone and methotrexate without antibiotics. She showed clinical and vision improvement without recurrences during the 1-year follow-up. Ocular sarcoidosis is an important differential diagnosis requiring careful anamnesis and ophthalmological examinations. Ancillary tests, such as X-ray radiography, tomography, and clinical and laboratory evaluations may help rule out other causes. Treatment mainly consists of corticosteroids and immunosuppression.
Highlights
Sarcoidosis is a systemic inflammatory disease that mainly affects Afro-descendant women 20-50 years old
We present a case of a patient who had bilateral posterior uveitis with vasculitis due to sarcoidosis and who was IgM positive for toxoplasmosis, which made early diagnosis difficult
Sarcoidosis is the cause of 2%-15% of all uveitis and is characterized by bilateral involvement (80%-90%) and a symmetrical clinical course
Summary
Sarcoidosis is a systemic inflammatory disease that mainly affects Afro-descendant women 20-50 years old. We present a case of a patient who had bilateral posterior uveitis with vasculitis due to sarcoidosis and who was IgM positive for toxoplasmosis, which made early diagnosis difficult. A 27-year-old Afro-descendant woman complained of headache, asthenia, night fever, and bilateral painful upper eyelid edema for 2 months. She had bilateral ocular pain for 7 days. Her best-corrected visual acuity (BCVA) was 20/20 in both eyes (OU) She presented with bilateral superior temporal eyelid edema, and anterior biomicroscopy revealed conjunctival injection and anterior chamber cells 3+(1), without other alterations in OU. The patient showed clinical improvement, and after 1 year of follow-up, she presented without systemic or ocular complaints, with a BCVA of 20/20 in OU. Disclosure of potential conflicts of interest: None of the authors have any potential conflict of interest to disclose
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