We appreciate Dr Gonzalez-Granado's interest generated by our illustrations of uveitis and white matter abnormalities in pediatric sarcoidosis.1 The suggestion to measure serum IgG levels to rule out CVID is significant. Our patient has no history of recurrent infections after 4 years of follow-up since the initial presentation. Although our article was submitted for the Images in Neurology section and the clinical synopsis was thus abbreviated, we believe the patient's presentation was indicative of neurosarcoidosis given the systemic illness, ophthalmologic findings, and laboratory studies in this previously healthy adolescent. We are happy to add that the patient's quantitative IgG level was in the reference range (779 mg/dL; reference range, 522-1703 mg/dL; to convert to grams per liter, multiply by 0.01), and thus IgG deficiency associated with CVID was ruled out. While our article was brief, with an emphasis on imaging, the additional epidemiologic point of clinical onset following a 3-day rural sojourn is notable. There is an association with sarcoidosis and exposure to irritants found in rural settings, including emissions from wood-burning stoves and tree pollen.2 Thus, our case of acute uveitis and white matter lesions in an adolescent with neurosarcoidosis has multiple teaching points.
Pearl PL, Miller AK, Khademian Z. Uveitis and Pediatric Sarcoidosis: Does IgG Really Matter?—Reply. Arch Neurol. 2011;68(1):135–138. doi:10.1001/archneurol.2010.329
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