Orbital sarcoidosis. Case report

Abstract

AbstractPurpose: Sarcoidosis is an autoimmune granulomatous disease that can affect any organ system in the body. Orbital manifestations are relatively uncommon. We present the clinical features and management in a case report with orbital sarcoidosis.Methods: This case report study a 51 year‐old female patient being investigated for headache, blurred vision and diplopia of 7 days onset. She had proptosis of the left eye, diplopia and complete ophthalmoparesis on supraversion and abduction and partial on adduction. The magnetic resonance showed probable orbital inflammation (inflammatory pseudotumor)/Tolosa Hunt syndrome with predominant involvement of the left superior rectus muscle, cavernous sinus, and pachymeninges. Chest X‐ray showed no pathological findings and laboratory tests, thyroid profile, serology, IgG subclasses, angiotensin converting enzyme and autoantibodies were negative. The computed tomography (CT) showed pulmonary lesions compatible with stage III sarcoidosis. After the results of the imaging tests, it was decided to start treatment with a bolus of methylprednisolone for 5 days and then oral prednisone was started with clear clinical and radiological improvement. The mediastinal lymph node biopsy could not be performed due to the decrease in its size.Results: The patient was treated with decreasing doses of corticosteroids until the disappearance of the orbital and pulmonary radiological symptoms. It has been followed for 2 years without recurrence.Conclusions: The presentation of sarcoidosis simulating a pseudotumor is uncommon. Despite this, we must take it into account in the differential diagnosis. In our case, the presentation of CT showing a pulmonary lesion compatible with sarcoidosis and the improvement with corticoid treatment made us reinforce the suspicion of a diagnosis of sarcoidosis. In any case, the definitive diagnosis of this pathology is biopsy and pathological analysis.