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[Bilateral optic neuropathy revealing systemic sarcoidosis]
P Guilpain1, M A Andreu, N Cassoux
1Service de médecine interne, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France. pguilpain@wanadoo.fr
La Revue De Medecine Interne
|October 9, 2004
Summary
Systemic sarcoidosis can cause severe optic neuropathy, leading to vision loss. This case highlights the potential challenges in treating this rare ocular complication, even with aggressive therapies.
Area of Science:
- Ophthalmology
- Neurology
- Pulmonology
Background:
- Systemic sarcoidosis affects 25-60% of patients, often involving the eyes.
- Papilledema is a rare manifestation of ocular sarcoidosis.
Observation:
- A 43-year-old man experienced progressive bilateral visual loss due to papillitis.
- Thoracic CT revealed mediastinal and parenchymal involvement consistent with sarcoidosis.
- Biopsies confirmed giant-cell granulomas without necrosis.
Findings:
- The patient was diagnosed with sarcoidosis-related optic neuropathy.
- High-dose corticosteroids and combination therapy (prednisone, methotrexate, infliximab) showed limited efficacy.
- Rapidly progressive, bilateral visual loss despite treatment was noted.
Implications:
- This case underscores the potential severity and treatment challenges of sarcoidosis-associated optic neuropathy.
- Early recognition and multidisciplinary management are crucial for patients with ocular sarcoidosis.
- Further research into effective therapeutic strategies for sarcoid optic neuropathy is warranted.