Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA.
Department of Neurology & Rocky Mountain MS Center, University of Colorado School of Medicine, Aurora, Colorado, USA.
Ocul Immunol Inflamm. 2024 Feb;32(2):181-183. doi: 10.1080/09273948.2023.2236211. Epub 2023 Jul 19.
We report a case of intermediate uveitis in the setting of both systemic sarcoidosis and multiple sclerosis. A 68-year-old female was diagnosed with bilateral granulomatous intermediate uveitis and cystoid macular edema. Initial systemic work-up was unrevealing. The uveitis was treated successfully with local corticosteroid injections. Eighteen months after presentation, the patient developed new systemic symptoms. Additional testing revealed systemic lymphadenopathy, with biopsy showing non-caseating granulomas, leading to a diagnosis of sarcoidosis. However, MRI of the brain and spinal cord along with cerebrospinal fluid analysis was consistent with MS. The management of the uveitis and systemic inflammation was co-managed by ophthalmology, neurology, and rheumatology, and eventually controlled with leflunomide and rituximab. Patients can rarely have co-existing systemic sarcoidosis and multiple sclerosis. Although challenging to diagnose, radiographic findings and cerebrospinal fluid analysis can be helpful to differentiate multiple sclerosis and neurosarcoidosis. Management of these patients requires coordination between multiple specialties.
我们报告了一例系统性结节病和多发性硬化症并存的中间葡萄膜炎病例。一名 68 岁女性被诊断为双侧肉芽肿性中间葡萄膜炎和囊样黄斑水肿。初步的系统性检查结果未见异常。通过局部皮质类固醇注射成功治疗了葡萄膜炎。在出现症状 18 个月后，患者出现新的全身症状。进一步检查显示全身淋巴结病，活检显示非干酪样肉芽肿，导致结节病的诊断。然而，脑和脊髓的 MRI 以及脑脊液分析与多发性硬化症一致。眼科、神经科和风湿科共同管理葡萄膜炎和全身炎症的治疗，最终使用来氟米特和利妥昔单抗控制病情。患者可能会罕见地同时患有系统性结节病和多发性硬化症。尽管诊断具有挑战性，但影像学发现和脑脊液分析有助于区分多发性硬化症和神经结节病。这些患者的管理需要多个专业之间的协调。
