Qassoom Ayat, Raviv Sasportas Eshchar, Bar Asaf
Edith Wolfson Medical Center, Holon, Israel.
Harefuah. 2022 Oct;161(10):628-632.
A 68-year-old healthy female, with no past systemic or ocular history, presented with decreased vision in both eyes. On initial examination, there were extensive vitreal opacities in both eyes. On the following visit, bilateral panuveitis was newly observed, without otherwise systemic clinical manifestations. The patient responded well to treatment with systemic and topical steroids. Initial workup excluded tuberculosis and syphilis. Angiotensin-converting enzyme (ACE) was within normal range. In order to make a definitive diagnosis and to exclude lymphoma, we decided to perform a vitreous biopsy after 2-weeks of steroids withdrawal. After cessation of steroids, new lesions appeared beneath the right eye and over the nasal bridge. Moreover, iris nodules over the stroma, pupil's margin and anterior chamber angle were noticed in both eyes. Biopsy from a skin lesion demonstrated non-caseating granulomas, supporting diagnosis of sarcoidosis. A chest computed tomography (CT) scan demonstrated compatible radiologic findings of bilateral hilar and mediastinal lymphadenopathy. Sarcoidosis is a chronic multisystem, autoimmune, granulomatous disease. Ocular involvement is common among patients with sarcoidosis, with the most common ocular manifestation being uveitis. We report a case that presented with bilateral panuveitis due to sarcoidosis with no systemic manifestations or elevated serum biomarkers. Definitive diagnosis was verified in histopathological findings from a skin biopsy and radiological findings in chest CT.
一名68岁健康女性,既往无全身或眼部病史,出现双眼视力下降。初诊时,双眼存在广泛的玻璃体混浊。复诊时,新发现双侧全葡萄膜炎,无其他全身临床表现。患者对全身及局部使用类固醇治疗反应良好。初步检查排除了结核病和梅毒。血管紧张素转换酶(ACE)在正常范围内。为了做出明确诊断并排除淋巴瘤,我们决定在停用类固醇2周后进行玻璃体活检。停用类固醇后,右眼下方和鼻梁上方出现了新的病变。此外,双眼均在虹膜基质、瞳孔边缘和前房角发现了虹膜结节。皮肤病变活检显示非干酪样肉芽肿,支持结节病的诊断。胸部计算机断层扫描(CT)显示双侧肺门和纵隔淋巴结肿大,与结节病的影像学表现相符。结节病是一种慢性多系统自身免疫性肉芽肿性疾病。眼部受累在结节病患者中很常见,最常见的眼部表现是葡萄膜炎。我们报告一例因结节病导致双侧全葡萄膜炎的病例,无全身表现或血清生物标志物升高。通过皮肤活检的组织病理学结果和胸部CT的影像学结果证实了明确诊断。