Choroidal sarcoid granuloma: a case report and review of the literature

Abstract

Background Choroidal sarcoid granulomas are often diagnosed in patients without a prior history of sarcoidosis. They are often mistaken for choroidal metastasis, choroidal nevi, amelanotic choroidal melanomas, and uveal lymphomas; however, are easily treatable when accurately identified. Observations We searched PubMed, Medline, and Scopus for English-Language case reports published before September 2021. Additionally, we presented a case of a 45-year-old woman with a right-sided amelanotic choroidal mass whose diagnosis was delayed by a COVID-19 infection. Of the 26 cases reported in the literature, 46% were female, 38% were African American, and 19% had bilateral involvement. There was a mean age of 42.15 years and a mean follow-up period of 27 months. The most common complaint was of a progressive, painless blurring of vision, and only five patients had been previously diagnosed with sarcoidosis. The choroidal granulomas were typically described as yellow lesions, single or multiple, found temporal to or at the macula. Most patients were administered steroids, with 69% receiving them systemically, 5% topically, and 8% locally with a triamcinolone injection. All patients reported symptomatic improvement at their final follow-up with resolution of the mass in 65% of patients and improved visual acuity in 76%. Conclusion Primary testing including fundoscopy, fluorescein angiography, fundus autofluorescence, A/B-scan, and OCT are useful for diagnosis, differentiation from other choroidal lesions, and monitoring treatment response. Steroids are a mainstay of treatment for sarcoidosis and are effective at treating choroidal granulomas. Therefore, early recognition and diagnosis of choroidal granulomas is imperative as treatment can be curative and sight-sparing.

Insights into the diagnosis and management of sarcoid uveitis: A review

“…FA shows early hypofluoresecence with late hyperfluorescence, and hypofluorescence in all phases on ICG‐A. Hyperautofluorescence in metastases corresponds to lipofuscin and subretinal fluid 87 …”

“…Hyperautofluorescence corresponds to lipofuscin in melanomas. 87 F I G U R E 6.9 | Multimodal imaging choriodal metastatses versus sarcoid granuloma…”

“…In a review of 26 cases of sarcoid choroidal granulomas reported in the literature, Hage et al 87 found nine cases with ultrasonography findings. Sarcoid choroidal granulomas were elevated in four of these cases, two cases demonstrated high internal reflectivity, one case showed the presence of calcium, one was associated with subretinal fluid and one was associated with a retinal detachment.…”

“…EDI‐OCT in melanomas demonstrates shaggy photoreceptors, subretinal deposits, subretinal fluid and changes in the overlying retina and homogenous optical reflectivity along the anterior surface, with gradual shadowing more deeply (Figure 7C). 90 Melanomas are acoustically hollow (B‐scan) with low internal reflectivity (A‐scan) 87 . Melanomas demonstrate a double circulation with extensive leakage on FA, and deep areas of microcirculation and late‐phase smooth, well‐demarkated hypofluorescent areas on ICG‐A.…”

“…Melanomas demonstrate a double circulation with extensive leakage on FA, and deep areas of microcirculation and late‐phase smooth, well‐demarkated hypofluorescent areas on ICG‐A. Hyperautofluorescence corresponds to lipofuscin in melanomas 87 …”