Uveitis with Biopsy-proven Sarcoidosis in Chinese—A Study of 60 Patients in a Uveitis Clinic Over a Period of 20 Years

Abstract

A marked increase was noted since 2002. One of the causes is the performance of chest CT. Chest CT is useful to discover mediastinal lymphadenopathy and other lesions suggestive of sarcoidosis, as well as to help guide tissue confirmation in patients with peculiar uveitis features indicative of sarcoidosis. Female predominance and peak incidence of uveitis onset in the 6th decade of life were found. The posterior segment was the most common localization of uveitis in biopsy-proven sarcoidosis in Chinese.

Characteristics of Uveitis Presenting for the First Time in the Elderly: Analysis of 91 Patients in a Tertiary Center

“…Sarcoidosis was the most frequent etiology (37.4 %), including biopsy-proven sarcoidosis in 16 patients. In 3 of these patients, 18 F-FDG-PET identified occult sites, and subsequent mediastinal or subclavicular biopsy revealed a noncaseating granuloma without evidence of infection. In 12 other patients, the clinical suspicion of sarcoidosis (presumed sarcoidosis) was supported by a positive chest…”

“…13 A diagnosis of sarcoidosis was based on criteria very similar to those proposed by Abad et al 14 For these authors, sarcoidosis is considered proven when pathologic examination of biopsy material showed a noncaseating granuloma; presumed when the patients met at least 2 of 4 of the following criteria-pathologic chest radiography or computed tomography, predominantly CD4 lymphocytosis in BAL fluid, elevated serum ACE level, elevated gallium uptake-but biopsy results were normal or unavailable; and indeterminate when only 1 criterion is met. We used equally fluorine-18 fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) and gallium uptake to diagnose sarcoidosis-associated uveitis, based on previous studies showing that 18 F-FDG PET is more accurate than gallium for assessing both extrapulmonary and pulmonary involvement in sarcoidosis patients. 15,16 Cases of uveitis that were not associated with a detectable infectious agent or the above systemic disorders were classified as idiopathic.…”

Ocular sarcoidosis in Thailand

“…In Japan and China, a large increase in ocular sarcoidosis was noted over time. 5,6 It is not clear whether this increase is because of previous underdiagnosis or concerns a genuine increase of prevalence of ocular involvement. Sarcoidosis can remain subclinical for long periods of time and may also be mistaken for TB.…”

“…3 So far, it is not known whether the rarity of sarcoidosis in South-East Asia is genuine or whether sarcoidosis in this geographic area remains underdiagnosed. Prevalence of sarcoidosis among patients with uveitis in the West is B8-10%, 4 in Japan 13%, 5 and in India and Taiwan 4%, 4,6 but virtually no patients with ocular sarcoidosis have been identified in mainland China. 6,7 In Thailand, systemic sarcoidosis has rarely been diagnosed and so far, no cases with ocular sarcoidosis have been reported.…”

“…Prevalence of sarcoidosis among patients with uveitis in the West is B8-10%, 4 in Japan 13%, 5 and in India and Taiwan 4%, 4,6 but virtually no patients with ocular sarcoidosis have been identified in mainland China. 6,7 In Thailand, systemic sarcoidosis has rarely been diagnosed and so far, no cases with ocular sarcoidosis have been reported. 8,9 In this study, we explore the possibility of pulmonary sarcoidosis in 209 new consecutive patients with uveitis and describe ocular features of four Thai patients with signs of associated pulmonary sarcoidosis.…”