Choroidal granuloma as an initial manifestation of systemic sarcoidosis

Systemic sarcoidosis presenting as a choroidal nodule is a rare phenomenon, with limited reports in the past. We present a case of systemic sarcoidosis in a young adult male presenting as a solitary choroidal mass. The diagnosis was made based on elevated serum lysozyme, serum angiotensin-converting enzyme, negative Mantoux, and computed tomography (CT) scan of the chest. Ultrasound examination and fundus fluorescein angiography helped us to differentiate this lesion from choroidal melanoma. Magnetic resonance imaging (MRI) of brain was done to rule out neurosarcoidosis. Patient responded well to systemic steroid therapy, with marked resolution of the choroidal granuloma, and reduced size of mediastinal lymph nodes on repeat CT scan of the chest.