Solitary retinal granuloma as a presenting sign of sarcoidosis

A 31-year-old white patient was referred with a recent history of decreased visual acuity in his left eye. A raised, greyish-white lesion close to the optic nerve was the only ophthalmological finding. Upon systemic work-up a chest X-ray revealed enlarged pulmonary lymph nodes. A biopsy obtained during bronchoscopy led to the diagnosis of sarcoidosis. No other manifestation was noted. Following systemic steroid treatment the lesion regressed and visual acuity improved. Granulomatous inflammatory diseases have to be ruled out in cases of prominent greyish-white fundus lesions.