Acute posterior multifocal placoid pigment epitheliopathy as the initial manifestation of sarcoidosis
Journal of Ophthalmic and Vision Research. 2011; 6 (4): 338-343
Dans Anglais
| IMEMR
| ID: emr-146682
ABSTRACT
To report an undiagnosed case of systemic sarcoidosis manifesting with bilateral acute posterior multifocal placoid pigment epitheliopathy [APMPPE]. A 26-year-old Caucasian man was referred for management of unilateral visual loss together with a paracentral scotoma developing 2 weeks after a flu-like syndrome. Clinical signs and ancillary diagnostic investigations suggested APMPPE. Laboratory tests demonstrated elevated serum angiotensin converting enzyme and lysozyme levels. Chest CT-scan disclosed moderate hilar lymph node calcifications but QuantiFERON-TB gold test was negative and bronchoalveolar lavage and biopsies were unremarkable. Accessory salivary gland biopsy disclosed epithelioid and gigantocellular granuloma formation without caseum, confirming a diagnosis of sarcoidosis. The fellow eye was involved a few days later and the patient complained of dyspnea. Echocardiography disclosed severe granulomatous myocardial infiltration and high dose corticosteroids and intravenous cyclophosphamide were initiated. Systemic treatment controlled both cardiac and ocular lesions, and was tapered accordingly. The constellation of [white dot syndromes] and systemic symptoms necessitates a general work-up to exclude granulomatous disorders such as sarcoidosis or tuberculosis. Delayed diagnosis of cardiac sarcoidosis may have life-threatening consequences and the ophthalmologist may be the first physician to diagnose the condition
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Indice:
Méditerranée orientale
Sujet Principal:
Rétinopathies
/
Sarcoïdose
/
Angiographie fluorescéinique
/
Choroïde
/
Vascularite du système nerveux central
/
Tomographie par cohérence optique
/
Diagnostic différentiel
/
Épithélium pigmentaire de la rétine
/
Vert indocyanine
Type d'étude:
Enquête cas-témoins / Études cas/témoins
Limites du sujet:
Humains
/
Mâle
langue:
Anglais
Texte intégral:
J. Ophthalmic Vision Res.
Année:
2011
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