[Unilateral papillitis as the presenting symptom of neurosarcoidosis]

Sarcoidosis is a granulomatous, multisystemic disease, of unknown etiology. Its prevalence is low, 40 cases by 100,000 inhabitants in Northern European countries. Respiratory symptoms are the most common, however this disease can affect other vital systems. Neurooftalmological manifestations have been reported one out of five cases, such as uveitis, cranial nerves palsy, and choroiditis; papillitis is seldom described. When initial symptoms of sarcoidosis are neurological features (less than 5%), diagnosis is challenging.

We present two cases of neurosarcoidosis in our hospital, during the last two years, in patients without previous diagnosis, which came for loss of visual acuity. The diagnostic was achieved by magnetic resonanace white matter lesions hyperintenses in T2, computed tomography thoracic mediastinic adenopathy and elevated determinations of angiotensin-converting enzyme, according to diagnostic criteria of neurosarcoidosis published in 2004.

We propose to include neurosarcoidosis among known etiologies of unilateral papilitis. Since that, determination of angiotensin-converting enzyme should be performed in those cases.