Yet another case of ocular sarcoidosis

Abstract

Purpose To report a case of bilateral pan-uveitis resembling fungal and viral endophthalmitis in a patient who was ultimately diagnosed with sarcoidosis. Observation A 64-year-old female presented with a four-day history of painless vision loss in the right eye. She presented with multiple concurrent systemic complaints, including a history of oral and genital sores, patches of hypopigmented skin on her forearms, and occasional shortness of breath. Upon further examination, she was noted to have bilateral pan-uveitis, which was more severe in the right than left eye. Posterior pole examination of the right eye revealed dense vitritis with multiple large whitish round balls that seemed suggestive of fungal or viral endophthalmitis. Initial therapies included intravitreal (IVT) foscarnet and intravenous (IV) acyclovir, followed by IV amphotericin B and oral voriconazole, which did not improve ocular signs and symptoms. Further evaluations ruled out infectious etiologies and lymphoma. Chest computerized tomography (CT) scan revealed findings suggestive of sarcoidosis, which was confirmed with lung biopsy. Anti-viral and -fungal treatments were discontinued, and the patient was started on IV methylprednisolone followed by oral prednisone and mycophenolate mofetil. Ocular symptoms improved, and the patient remained stable after treatment. Conclusion and Importance The index report illustrates a case of ocular sarcoidosis that imitated the presentation of infectious endophthalmitis. Though ocular sarcoidosis is known to masquerade as a range of disorders and constitutes part of the differential diagnosis for infectious endophthalmitis, sarcoidosis has not been reported in recent literature to imitate the presentation of fungal endophthalmitis. The index case suggests that ocular sarcoidosis should be considered in the differential diagnoses of fungal endophthalmitis.

Fungal Endophthalmitis Secondary to Aspergillus terreus Exacerbated by Intravitreal Dexamethasone in a Patient With Sarcoidosis

“…18 The most common posterior segment finding in ocular sarcoidosis is vitritis, and ocular sarcoidosis has been reported to resemble fungal endophthalmitis, with dense vitritis and fungal ball-like vitreous opacities. 19,20 This case highlights the importance of maintaining a high suspicion for infectious causes of ocular inflammation even when there is a history of noninfectious uveitis flares.…”

Diagnosis of systemic sarcoidosis in a patient with bilateral granulomatous pan-uveitis: a case report

“…Treatment is directed towards reducing the inflammation, preventing further deterioration, and avoid drug toxicity 17 . Asymptomatic cases with minimal changes in the radiograph can have spontaneous remission such that systemic therapy is not routinely indicated but if needed, corticosteroids, immunosuppressive agents, and cytotoxic drugs can be given.…”

Ocular sarcoidosis in adults and children: update on clinical manifestation and diagnosis

“…Other causes of granulomatous uveitis may also be included especially in cases of atypical presentations or in immunocompromised patients: toxoplasmosis, lyme, cat scratch disease, cryptococcosis (in immunocompromised patients) or even endophthalmitis [ 46 ].…”