Clinical Features and Diagnostic Evaluation of Biopsy-Proven Ocular Sarcoidosis

Abstract

To compare the clinical characteristics of uveitic sarcoidosis in African American and non-African American patients with biopsy-proven sarcoidosis and to determine which diagnostic test results were most often suggestive of sarcoidosis in patients who were ultimately diagnosed as having the disease. Method: Retrospective review of consecutive patients with biopsy-proven sarcoidosis evaluated by the uveitis service between 1989 and 2009. Results: A total of 63 patients with uveitic sarcoidosis were identified: 39 (62%) were African American (PϽ.001) and 43 (68%) were female. African American patients presented at an earlier age (PϽ.001) and were more likely to have granulomatous anterior segment inflammation (PϽ.001). The levels of serum markers angiotensin-converting enzyme and lysozyme were elevated in 40% and 42% of patients tested, respectively. The levels of at least 1 marker were elevated in 18 patients (58%). Imaging study results were reported as consistent with sarcoidosis in 25 patients (69%) who underwent chest radiography and in 19 patients (100%) who underwent computed tomography. Conclusions: In this series, African American patients were more likely to be diagnosed as having uveitic sarcoidosis and to present with uveitis if they were younger than 50 years. White patients were more likely to present when they were older than 50 years. A clinical picture that included granulomatous anterior segment inflammation was more common in African American patients. The use of serum markers (angiotensinconverting enzyme and lysozyme) positively identified more patients with biopsy-proven sarcoidosis when used in combination with appropriate chest imaging.

Ocular sarcoidosis

“…Uveitis is more frequent and severe in African American patients compared with Caucasian [12]. Recent data show that sarcoid uveitis occurs in African American patients who are younger than 50 years compared with Caucasian patients [13]. Recent evidence from Japan shows that sarcoidosis is currently the most prevalent etiology of uveitis replacing Behçet's disease [14].…”

Update on sarcoidosis

“…African-American and Scandinavian populations have the highest risk of developing sarcoidosis [3]. The disease commonly presents at an earlier age in African-Americans, and the inflammation is more often granulomatous in nature [4]. A bimodal distribution has been described for the onset of sarcoidosis, and the vast majority of individuals presenting after age 50 is women [4,5].…”

“…Alone, a chest radiograph has been found to be about 79% sensitive for sarcoidosis [10]. The combination of chest imaging with serum ACE and lysozyme levels can identify the vast majority of patients with ocular inflammation secondary to sarcoidosis [4]. In addition, the radiographic staging system for sarcoidosis is based on chest radiograph findings and may carry prognostic value [11].…”

“…In addition, the radiographic staging system for sarcoidosis is based on chest radiograph findings and may carry prognostic value [11]. Thin-cut, spiral computed tomography (CT) imaging is more sensitive and may have utility in patients with negative chest radiograph and a high clinical suspicion for sarcoidosis [4][5][6][7][8][9][10][11][12]. Distinctive CT patterns of parenchymal, mediastinal and hilar structures can aid in diagnosis [13].…”

Practical diagnostic approach to uveitis

“…If this is recurrent, has it always The word uvea comes from the Latin word 'uva', which means 'grape' as defined by early anatomists based on the tissue color and geometry and consists of the iris, ciliary body and the choroid. Uveitis can refer to inflammation of one or all three components, may also include primary inflammations of the retina and vitreous, and is often found in connection with systemic disease [1][2][3]. The most critical question in evaluating a patient with intra ocular inflammation is whether the disease can be classified into a specific, defined syndrome.…”