Clinical examination and computed tomographic (CT) scan of the orbit revealed a postero-ocular mass, the biopsy of which showed a noncaseating, giant cellular, epithelioid granuloma compatible with sarcoidosis. The patient had no respiratory complaints, but the thoracic CT scan showed multiple bilateral hilar and mediastinal adenopathies. Gallium scan showed increased uptake in both hilar regions, in the left orbit and in the right parotid gland. Multiple bronchial biopsies revealed sarcoid granulomas, with a bronchoalveolar lavage (BAL) cytological pattern of active sarcoidosis. The evolution was favourable with prednisolone given at a dose of 0.5 mg·kg -1 daily.It is suggested that in an unusual presentation of sarcoidosis, a thorough search should be made for localization at other sites, lungs in particular, even in the absence of respiratory complaints. Eur Respir J., 1995, 8, 474-476 Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology most commonly affecting young adults, and presenting most frequently with bilateral hilar lymphadenopathy, with or without pulmonary infiltrates and skin or eye lesions [1]. Although virtually any part of the visual apparatus may be affected [2], orbital sarcoidosis taking the form of a tumour, without eyelid, eyeball or lacrymal gland involvement, is rare [3][4][5].We report a case of systemic sarcoidosis that initially presented as an orbital tumour.
Case reportA 73 year old obese woman with recently detected non-insulin-dependent diabetes presented with redness and itching of the left eye of 3 months' duration. Treatment for conjunctivitis had proved useless. The patient was referred to the ophthalmological clinic. On examination, the left conjunctiva was red and chemotic. There was proptosis of the left eye, with a Hertel exophthalmometer reading of 24 mm, and the ocular movements were diminished in all directions, without diplopia. A firm to hard, nonreducible and nontender mass was palpable on the medial sides of the superior and inferior parts of the orbital cavity. Visual acuity of the left eye was 8/10, and that of the right eye was 10/10. There was no evidence of uveitis, and ocular tension was normal in both eyes. On fundoscopy, papillary congestion with hypervascularity was seen in the left eye, which was confirmed by angio-fluoro-retinography. Goldman's perimetry did not show any defects in visual fields.Computed tomographic (CT) scan of the orbits showed a posterio-ocular mass extending to medial and superior regions and probably invading the left optic nerve ( fig. 1). There was no osteolytic lesion. Magnetic resonance imaging (MRI) of the orbit showed that the posterior ocular mass surrounded the left optical nerve, without invasion. Based upon these clinicoradiological findings, left orbital lymphoma was highly suspected. Biopsy
CASE REPORT