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VASCULARIZED SARCOID GRANULOMA COMPLICATED BY PLACOID DISEASE IN A PEDIATRIC PATIENT
1Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Insights
This case report details a pediatric patient with sarcoidosis presenting as a vascularized choroidal granuloma and subsequent placoid inflammation. Early diagnosis and treatment are crucial for preserving vision in children with atypical uveitis.
Area of Science:
- Ophthalmology
- Pediatrics
- Rheumatology
Background:
- Pediatric uveitis can present atypically, challenging diagnosis and management.
- Sarcoidosis is a multisystem inflammatory disease that can affect the eyes.
Observation:
- A 10-year-old girl presented with vision loss due to a macular lesion initially misdiagnosed as neovascularization.
- Optical coherence tomography revealed a vascularized granuloma with subretinal fluid, treated with anti-VEGF injections.
- Recurrent inflammation occurred, leading to a diagnosis of sarcoidosis with placoid chorioretinopathy.
Findings:
- Vascularized sarcoid choroidal granuloma in a child.
- Complicated by placoid-like inflammatory response.
- Successful initial treatment with anti-VEGF, followed by oral steroids for inflammation.
Implications:
- Atypical uveitic presentations in children necessitate a broad differential diagnosis.
- Exclusion of infectious causes is vital when managing granulomatous uveitis.
- Prompt and appropriate therapy is essential to prevent vision loss in pediatric uveitis.
Purpose:
To report a case of pediatric vascularized sarcoid choroidal granuloma complicated by placoid-like inflammation.
Methods:
Case report.
Results:
A 10-year-old girl presented with blurry vision in her right eye and a yellowish macular lesion that had been diagnosed as fibrotic choroidal neovascular membrane and observed for several months. On referral to our clinic, optical coherence tomography revealed a homogeneous hyperreflective lesion obliterating the choroidal vasculature and protruding under the retina with associated subretinal and intraretinal fluid. Optical coherence tomography angiography revealed vascularization of this granulomatous lesion, and the girl underwent six intravitreal injections of anti-vascular endothelial growth factor, with reabsorption of the fluid and consolidation of the lesion. A sudden, abrupt decrease in the visual acuity of the right eye 3 months after the last injection was accompanied on optical coherence tomography by hyperreflective inflammatory lesions breaking from the retinal pigment epithelium and involving the outer nuclear layer, all around the fibrotic granulomatous lesion. The girl was treated with oral steroids, and an extensive systemic evaluation revealed hilar adenopathy, thus posing the diagnosis of pediatric sarcoidosis complicated by placoid chorioretinopathy.
Conclusion:
Atypical presentations of typical uveitic diseases are quite common in children. The presence of a foveal vascularized granuloma complicated by a placoid disorder should prompt the exclusion of infectious etiologies such as tuberculosis, to establish a therapy to preserve the child's vision.
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