Sarcoidosis presenting as fulminant bilateral multifocal choroiditis

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Sarcoidosis is a systemic inflammatory disease characterized by non-caseating granulomas.
• Ocular involvement in sarcoidosis is common but can present atypically.
• Fulminant bilateral multifocal choroiditis is a rare but severe manifestation of ocular inflammation.

Purpose of the Study:

• To report a case of sarcoidosis presenting with fulminant bilateral multifocal choroiditis.
• To highlight the diagnostic challenges when typical sarcoidosis markers are normal.
• To emphasize the importance of extrathoracic lymph node biopsy for diagnosis.

Main Methods:

• Case report of a 32-year-old man with acute visual loss and systemic symptoms.
• Diagnostic workup included fundus autofluorescence, optical coherence tomography (OCT), and laboratory tests.
• Excisional biopsy of an inguinal lymph node confirmed non-necrotizing granulomas consistent with sarcoidosis.

Main Results:

• The patient presented with rapidly progressive bilateral central scotomas and multifocal deep retinal lesions.
• Initial investigations, including serum ACE and thoracic imaging, were normal.
• High-dose systemic corticosteroids led to rapid visual improvement, followed by methotrexate for maintenance.

Conclusions:

• Sarcoidosis can manifest as fulminant multifocal choroiditis despite normal serum ACE and thoracic imaging.
• Peripheral lymphadenopathy, including inguinal nodes, is a crucial examination finding for diagnosis.
• Early tissue confirmation via biopsy and prompt immunosuppression are vital for visual recovery.