Choroidal granuloma in sarcoidosis

Area of Science:

• Ophthalmology
• Rheumatology
• Oncology

Background:

• Sarcoidosis can present with ocular manifestations.
• Choroidal tumors are a diagnostic challenge, often mimicking metastatic carcinoma.

Observation:

• Two patients presented with pale yellow choroidal tumefactions and subretinal fluid, initially suspected as metastatic choroidal carcinoma.
• Both patients had sarcoidosis confirmed via systemic investigation, leading to a diagnosis of presumed sarcoid choroidal infiltration.
• Ocular examination revealed absence of inflammation in the retina, retinal vessels, and vitreous cavities.

Findings:

• Fluorescein angiography showed hypofluorescence followed by late hyperfluorescence; ultrasonography revealed medium internal reflectivity.
• Neither imaging modality could definitively exclude metastatic choroidal carcinoma.
• One patient showed elevated angiotensin-converting enzyme levels correlating with improved vision and granuloma flattening during corticosteroid treatment, though resolution was only partial.

Implications:

• Choroidal granuloma can be the sole ocular manifestation of sarcoidosis, posing a diagnostic challenge and differential for metastatic choroidal carcinoma.
• Biopsy confirmation is essential for accurate diagnosis of sarcoidosis and exclusion of malignancy, as noninvasive tests like gallium scans and angiotensin-converting enzyme levels are insufficient.
• Corticosteroid therapy may partially improve vision and reduce granuloma size but does not guarantee complete resolution.