Castagna I, Salmeri G, Famà F, Trombetta C J, Ricci R, Traclò C D
University Eye Clinic, Messina, Italy.
Ophthalmologica. 1994;208(4):230-2. doi: 10.1159/000310495.
We report a rare casse of optic nerve involvement as the first sign of systemic sarcoidosis. A 43-year-old white woman presented with visual loss in her right eye, and the clinical appearance of optic nerve head swelling. Visual acuity was reduced to 20/200, and the only clinical signs were the presence of an enlarged optic nerve head, with engorged retinal veins and flame-shaped haemorrhages. Computed tomography scans showed an enlarged orbital portion of the right optic nerve, which was confirmed by magnetic resonance imaging. With a diagnosis of optic nerve tumour (possibly glioma) a surgical resection of the tumour was performed. Histopathology showed multiple nodular granulomas with epithelioid cells, consisted with the diagnosis of sarcoidosis. This was confirmed by systemic involvement of the parotids and liver. We review the literature and consider all possible involvement of the optic nerve in sarcoidosis. The rarity of systemic sarcoidosis with a first manifestation as papilloedema is discussed.
我们报告了一例罕见的以视神经受累为系统性结节病首发症状的病例。一名43岁的白人女性出现右眼视力丧失及视神经乳头肿胀的临床表现。视力降至20/200，唯一的临床体征是视神经乳头肿大，视网膜静脉充盈及火焰状出血。计算机断层扫描显示右侧视神经眶内段增粗，磁共振成像证实了这一点。诊断为视神经肿瘤（可能为胶质瘤）后，进行了肿瘤手术切除。组织病理学显示多个结节性肉芽肿伴上皮样细胞，符合结节病的诊断。腮腺和肝脏的系统性受累证实了这一诊断。我们回顾了文献并考虑了结节病中视神经所有可能的受累情况。讨论了以视乳头水肿为首发表现的系统性结节病的罕见性。
