Clinical and Multimodal Imaging Clues in Differentiating Between Tuberculomas and Sarcoid Choroidal Granulomas

Agarwal, Aniruddha; Aggarwal, Kanika; Pichi, Francesco; Tian, Meng; Munk, Marion R.; Bazgain, Krinjeela; Bansal, Reema; Agrawal, Rupesh; Gupta, Vishali

doi:10.1016/j.ajo.2021.01.025

Cited by 23 publications

(11 citation statements)

References 47 publications

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“…Peripapillary granulomas occur in 1–5% of patients with sarcoidosis and was first reported in 1964 [ 4 , 5 ]. ICG imaging of sarcoid choroidal granulomas typically show hypocyanescent spots in the early and intermediate phase, which become isocyanescent or hypercyanescent in the late phase [ 6 , 7 ]. Our case was particularly challenging because demonstration of granulomatous inflammation, primarily within the subretinal space has not been previously described and intraocular biopsy is uncommon in sarcoidosis.…”

Section: Discussionmentioning

confidence: 99%

Subretinal peripapillary biopsy-proven sarcoidosis: a case report

et al. 2022

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Background To report a case of a subretinal, unilateral, peripapillary granuloma that was diagnosed as sarcoidosis by a 27-gauge pars plana vitrectomy subretinal biopsy. Sarcoidosis is a chronic idiopathic granulomatous inflammatory disease, that has ocular involvement in 10–80% of patients. It is often mistaken for many other primary ocular diseases because the condition can involve any structure in or around the eye. Previous case reports of peripapillary sarcoidosis have either been limited to the choroid or presented with additional ocular and systemic signs, hence have not required an intraocular biopsy. Case presentation A 54-year-old Filipino male presented with a 6-month history of painless blurred vision in his right eye. Fundus examination revealed a large white peripapillary lesion. Enhanced-depth imaging optical coherence tomography confirmed the subretinal location of the mass. Indocyanine green angiography demonstrated absolute hypofluorescent blockage with satellite lesions. A whole-body positron emission tomography scan demonstrated widespread lymphadenopathy, but investigations including an inguinal lymph node biopsy were inconclusive. Following growth of the peripapillary lesion and worsening vision, a 27-gauge pars plana vitrectomy subretinal biopsy was performed which confirmed sarcoidosis. He was treated with oral corticosteroids and transitioned to long term immunotherapy with methotrexate. Conclusions Sarcoidosis can present in the subretinal space, around the optic nerve without other ocular findings.

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Section: Discussionmentioning

confidence: 99%

Subretinal peripapillary biopsy-proven sarcoidosis: a case report

et al. 2022

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“…Granulomas secondary to sarcoidosis were also more likely to be associated with retinal vasculitis, and disc hyperfluorescence was present in every fluorescein angiogram. [ 29 ] Fig. 1 demonstrates an example of a choroidal granuloma and subretinal fluid in a patient with sarcoidosis.…”

Section: Imaging and Laboratory Investigations In The Diagnosis Of Oc...mentioning

confidence: 99%

“…Agarwal et al . [ 29 ] described the increased likelihood of sarcoidosis having concurrent retinal vascular changes on fluorescein angiography as well as disc leakage. Retinal vasculitis secondary to tuberculosis was more likely to be occlusive and associated with pinpoint retinal pigment epithelium (RPE) leaks surrounding the main choroidal granuloma.…”

Section: Imaging and Laboratory Investigations In The Diagnosis Of Oc...mentioning

confidence: 99%

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Progress in the diagnosis of ocular sarcoidosis

O’Keefe¹,

Rao

2022

Indian Journal of Ophthalmology

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Sarcoidosis is a multisystem granulomatous inflammation that affects multiple organ systems. The spectrum of extraocular and ocular involvement is wide and may precede systemic involvement. The diagnosis of ocular sarcoidosis relies on a combination of clinical findings, laboratory investigations, and radiographic findings. These include but are not limited to serum angiotensin-converting enzyme (ACE), lysozyme, plain-film radiographs of the chest, computed tomography (CT) scans of the chest, pulmonary function testing, bronchoalveolar lavage, and retinal imaging among others. In this review, we highlight current and evolving systemic investigations and approaches to ophthalmic imaging when considering the diagnosis of ocular sarcoidosis.

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“…Recently, Agarwal et al . [ 7 ] described various clinical and multimodal imaging clues to differentiate tuberculoma and sarcoid granuloma. Tuberculoma tends to be solitary, intensely yellow, larger, full-thickness, lobulated and is associated with hemorrhage and exudation.…”

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confidence: 99%