Solitary choroidal mass as the presenting sign in systemic sarcoidosis.

Abstract

SUMMARY A solitary choroidal mass with an overlying neurosensory retinal detachment was seen in an otherwise healthy 25-year-old Caucasian female. Ocular and general physical examinations, serum chemistry, and pathological examination of a lymph node biopsy confirmed sarcoidosis as the cause for the choroidal mass. Treatment with systemic steroids resulted in resolution of the lesion and return of normal visual acuity. Case reportA 25-year-old Caucasian female was seen by her local ophthalmologist and referred for retinal examination because of central blurring in her left eye for the previous 3 days. The patient noticed no redness, pain, or photophobia. Ocular history revealed one sister who was noted to have a unilateral eye defect which by history was suggestive of a coloboma. The sister was not examined. Past medical history was negative except for an upper respiratory infection one month prior to ocular examination. Four months previously the patient had given birth to a full-term, healthy child, delivered by caesarean section because of prolonged labour. After delivery the patient had a raised white blood count, the cause of which was never determined. There was no history of fever, weight loss, or anorexia. The patient abused neither drugs nor alcohol.Ocular examination revealed best corrected visual acuity of 20/20 OD, 20/100 OS. Applanation intraocular tensions were 12/13. External examination was normal. The pupils were 4 mm, equal, round, and reacted to light directly and consensually without an afferent defect. A muscle balance test showed orthophoria. Motility tests revealed full ductions and versions. A photo stress test showed a delay on the left greater than one minute compared with the right. American Optical colour plates showed 12 of 15 correct OD, 0 of 15 OS. An Amsler grid test showed a central scotoma OS. Slit-lamp examination of the anterior segment was unremarkable in both eyes.

Visual loss in sarcoid‐related uveitis

“…Subfoveolar neovascularization has been reported in sarcoidosis 15 . Chorioretinitis in association with sarcoidosis was described as long ago as 1925 16 , and generally occurs with anterior uveitis and vitritis, although isolated choroidal lesions do occur 17 . Bienfait and Baarsma noted multiple focal chorioretinal lesions in six of 16 patients with sarcoid uveitis, three of whom developed macular oedema, one artery occlusion, one vitreous haemorrhage and all six of whom had a poor visual outcome 11 .…”

A Case of Large Sarcoid Choroidal Granuloma Treated with Steroid Pulse Therapy

“…Fundus findings of this disorder mimic those of a choroidal tumor in many respects [3], and thus, a general examination including head CT/magnetic resonance imaging is important. There are many reports of sarcoidosis being diagnosed histologically, especially in order to differentiate it from a metastatic choroidal tumor or a choroidal malignant melanoma [4][5][6]11]. In our present case, whole-body contrast-enhanced CT revealed enlarged lymph nodes throughout the patient's body, including both sides of the neck, the supraclavicular fossa, both sides of the mediastinum, and the pulmonary hilum.…”

“…Unlike usual ocular sarcoidosis, this pathology commonly shows mild inflammation in the anterior eye or the vitreous body and often presents diagnostic difficulties. The lesion is welldefined and pale yellow, and the size ranges between 1 and 10 PD [3][4][5]. Fluorescein angiography examination shows low fluorescence or punctate hyperfluorescence corresponding to the lesion at the early phase and hyperfluorescence from the middle to late phase.…”

Solitary Idiopathic Choroiditis

“…Ultrasonography is of little diagnostic value since the lesions are generally very small and shallow [ 1 ]. The aetiology of SIC is not known and the differential diagnosis includes all the conditions that can cause a choroidal granuloma: sarcoidosis [ 7 , 8 , 9 , 10 ], tuberculosis [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ], ocular toxocariasis [ 18 ], and cat-scratch disease [ 19 ] among others. In fact, since gamma-interferon testing was not available at the time Shields et al [ 1 ] published their series, we can speculate that some of the SIC cases could be manifestations of extrapulmonary tuberculosis and so anti-tuberculous therapy would be justified in cases with active choroidal lesions with markedly raised QuantiFERON titres.…”