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JAMA Ophthalmology Clinical Challenge
May 2014

A Complicated Case of Sarcoidosis

Author Affiliations
  • 1Institute of Ophthalmology and Visual Science, Rutgers–New Jersey Medical School, Newark, New Jersey
JAMA Ophthalmol. 2014;132(5):649-650. doi:10.1001/jamaophthalmol.2014.179

A man in his 50s presented with blurred vision in his right eye greater than in the left. His medical history included squamous cell carcinoma of the lung diagnosed 1 year prior, which was resected. On examination, his visual acuity was 20/30 OD and 20/25 OS and he had mutton fat keratic precipitates and 1+ cells in both eyes. The vitreous and retina revealed no signs of inflammation. The day before, he had undergone a positron emission tomography scan to look for evidence of metastatic lung cancer. The result revealed mild to moderate diffuse lymphadenopathy in the neck, axillae, mediastinal, and inguinal regions. The symmetric pattern favored a diagnosis of sarcoidosis; metastatic disease was less likely. Because the scan was consistent with a diagnosis of sarcoidosis in this patient with granulomatous anterior iritis, no further laboratory testing was pursued. The patient started treatment with prednisolone acetate, 1%, 4 times daily in both eyes. A lymph-node biopsy showed lymphoid follicular hyperplasia and nonnecrotizing granulomatous inflammation, consistent with sarcoidosis. There was no evidence of lymphoma. The results of special stains were negative for bartonella, fungal organisms, and mycobacterial infection (Figure 1A).

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