Sarcoidosis Presenting with Bilateral Optic Disc Edema as the Initial Presentation

Area of Science:

• Ophthalmology
• Neurology
• Rheumatology

Background:

• Sarcoidosis is a multisystem granulomatous disease of unknown cause.
• Ocular involvement is common, typically presenting as granulomatous anterior uveitis.
• Optic nerve involvement at initial presentation is rare.

Observation:

• A 43-year-old man presented with eye pain, decreased vision, floaters, bilateral papillitis, vitritis, and cystoid macular edema.
• Diagnostic workup including serum angiotensin-converting enzyme levels, thoracic CT, and lymph node biopsy confirmed sarcoidosis.
• This case demonstrated sarcoidosis presenting primarily with optic nerve inflammation without characteristic granulomatous uveitis.

Findings:

• Successful treatment was achieved using methylprednisolone and immunosuppressive therapy.
• The patient experienced no relapse or systemic progression of sarcoidosis.
• This highlights an atypical presentation of ocular sarcoidosis.

Implications:

• Sarcoidosis should be considered in the differential diagnosis of optic nerve inflammation, even in the absence of typical ocular signs like granulomatous inflammation or vasculitis.
• Early recognition and treatment can lead to favorable outcomes.
• Broadens the understanding of sarcoidosis's diverse clinical manifestations in the optic nerve.