The Evolution of an Optic Nerve Head Granuloma Due to Sarcoidosis

Hickman, Simon J.; Quhill, Fahd; Pepper, Irene M

doi:10.3109/01658107.2015.1134587

Cited by 16 publications

(7 citation statements)

References 19 publications

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“…In another case report, a 27-year-old woman presented with headache, fevers, and bilateral painful upper eyelid edema for two months. She also had bilateral ocular pain for seven days [5]. In addition to ocular manifestation of sarcoidosis, this patient also had pulmonary involvement as do most patients in case reports.…”

Section: Discussionsupporting

confidence: 55%

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A rare case of solitary optic nerve sarcoidosis mimicking an ocular tumor

Wesolow¹,

Ramsakal²

2019

Int J Case Rep Images

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Introduction: Sarcoidosis is often an overlooked differential diagnosis in many disease processes. It is a nonspecific inflammatory disease marked by granulomas. Being nonspecific makes it a more difficult disease to diagnose. It is a challenging diagnosis as it is a great mimicker of many other conditions and therefore missed. The finding of a granuloma is not specific for sarcoidosis as other disorders may present with granulomas. It is an important differential to keep in mind because of significant morbidity and mortality associated with this disease. Case Report: Here we present a case of a female patient with vision loss and an intracranial mass. The mass was initially thought to be cancer and hence referred to our Cancer Center for further evaluation and workup. Upon biopsy the mass was diagnosed as sarcoidosis. She had no other systemic involvement at time of diagnosis. What makes this case of sarcoidosis rare is her solitary optic nerve involvement. Conclusion: Sarcoidosis is a more difficult disease to diagnose than other diseases, such as coronary artery disease, hyperlipidemia, and diabetes as these diseases have very specific, easily accessible

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Section: Discussionsupporting

confidence: 55%

“…Anterior chamber inflammation is one of the most clinical signs of sarcoid uveitis. It was detected in >90% patients with biopsy-proven sarcoid uveitis in one study [5]. Typical clinical presentations in patients with anterior chamber inflammation can include pain, erythema, and worsening vision [6].…”

Section: Discussionmentioning

confidence: 96%

A rare case of solitary optic nerve sarcoidosis mimicking an ocular tumor

Wesolow¹,

Ramsakal²

2019

Int J Case Rep Images

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“…NS however can cause secondary pathology in the eye [ 5 , 7 , 9 , 29 ]. Optic nerve head granuloma can be the first presentation of NS [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

An atypical case of neurosarcoidosis presenting with neovascular glaucoma

Vereecken

Hollanders

Bruyn

et al. 2018

J Ophthal Inflamm Infect

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BackgroundSarcoidosis, a multisystem, granulomatous disorder, sometimes manifests with a neuro-ophthalmic subtype. The latter can pose a diagnostic challenge, especially when ocular symptoms appear before systemic involvement, as the clinical picture then can be non-specific and systemic laboratory and standard imaging investigations can be negative.FindingsA 71-year-old woman presented with a 4-month history of sudden-onset visual loss in the left eye. Slit lamp examination revealed anterior chamber cells, iris, and angle neovascularization. Fundoscopy showed a pale edematous optic nerve head surrounded with intraretinal hemorrhages and yellow retinal infiltrates. The vasculature was very narrow to absent. Indeed, fluorescein angiography filling was limited to the (juxta-)papillary region. An extensive systemic work-up revealed a monoclonal gammopathy and absence of any inflammatory markers. On MRI, a mass infiltration of the intraorbital and the intracranial optic nerve was visible. Additional PET-CT scan revealed hilar lymph nodes. A transbronchial biopsy demonstrating a non-caseating granulomatous lesion led to the diagnosis of sarcoidosis and thus neurosarcoidosis. Treatment with high-dose prednisone and azathioprine was started to avoid progression and subsequent visual loss in the other eye.ConclusionsA patient with neurosarcoidosis presenting with compressive ischemic optic disc edema and neovascular glaucoma is described, increasing the diversity of clinical presentations and confirming the diagnostic challenge of neurosarcoidosis.

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“…Diagnosing neurosarcoidosis without the involvement of other organs is very challenging. Due to its unspecific clinical manifestation and laboratory findings, neurosarcoidosis can masquerade as optic neuritis, optic nerve sheath meningioma, a metastatic tumour, or a variety of other issues [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Neurosarcoidosis presenting as CRVO combined CRAO: a biopsy-proven case report of a Chinese patient

et al. 2020

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Background: Neurosarcoidosis is a rare systemic disorder that can affect the eye and other organs, including the central nervous system. Neurosarcoidosis infiltrating the optic nerve presenting as central retinal vein occlusion combined with artery ischaemia has not been reported in the literature previously. We describe a Chinese patient presenting with acute monocular vision loss, in whom an optic nerve biopsy confirmed the diagnosis of neurosarcoidosis. Case presentation: A 47-year-old woman complained of acute decreased vision in her left eye over the course of 1 month. She reported that her vision deteriorated quickly within first 3 days of consulting an ophthalmologist at a local hospital. She was diagnosed with central retinal vein occlusion after funduscopic examination and fundus fluorescein angiography, and the vision in her left eye further deteriorated to no light perception. An orbital magnetic resonance imaging showed an abnormal T1-weighted image of the optic nerve after contrast enhancement. She was referred to a neuro-ophthalmologist for further evaluation. After routine blood tests ruled out infectious and metastatic diseases, she was prescribed 500 mg/d methylprednisolone for 5 days, but her vision did not improve. As she could still not perceive light, an optic nerve biopsy was performed, and the histopathology revealed non-necrotising granuloma that was consistent with neurosarcoidosis. Conclusions: Isolated optic nerve infiltration by neurosarcoidosis without the involvement of the central nervous system or other systemic organs is challenging to diagnose. Biopsy of the optic nerve sheath is crucial for the final diagnosis of neurosarcoidosis. Therefore, a comprehensive ophthalmologic and systemic examination and work-up for inflammation of the eye, chest, and central nervous system should be conducted for atypical cases.

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The Evolution of an Optic Nerve Head Granuloma Due to Sarcoidosis

Cited by 16 publications

References 19 publications

A rare case of solitary optic nerve sarcoidosis mimicking an ocular tumor

A rare case of solitary optic nerve sarcoidosis mimicking an ocular tumor

An atypical case of neurosarcoidosis presenting with neovascular glaucoma

Neurosarcoidosis presenting as CRVO combined CRAO: a biopsy-proven case report of a Chinese patient

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