Choroidal granuloma in sarcoidosis.

We examined two patients--a 33-year-old black man and a 62-year-old white woman--who had pale yellow choroidal tumefactions with subretinal fluid and reduced vision. One patient had a history of granulomatous iritis; both patients were initially thought to have metastatic choroidal carcinoma. Systemic investigation yielded positive tissue diagnosis for sarcoidosis, leading to the diagnosis of presumed sarcoid choroidal infiltration. There was striking absence of inflammation of the retina, retinal vessels, and vitreous cavities. Fluorescein angiography disclosed initial hypofluorescence and late hyperfluorescence and ultrasonography demonstrated medium internal reflectivity. Neither study could exclude metastatic choroidal carcinoma. One patient had an increased level of angiotensin-converting enzyme on serial determinations through 15 months of observation and during treatment with corticosteroids, indicating a good correlation with improved vision and flattening of the choroidal granuloma. In both cases there was only partial resolution of the choroidal granuloma with corticosteroids. We conclude that choroidal granuloma can be the sole ocular manifestation of sarcoidosis and in this context is likely to be confused with metastatic choroidal carcinoma. We also believe that biopsy confirmation is needed because noninvasive tests such as gallium scans and angiotensin-converting enzyme cannot be relied on for diagnosing sarcoidosis and excluding carcinoma.