Sarcoidosis presenting as lacrimal gland enlargement: Eyes speak the truth

Abstract

Bilateral lacrimal gland enlargement is uncommon; however, its presence induces brainstorming process and intensive discussion between a clinician and an imaging specialist, leading to exploration of multiple systemic disease patterns such as lymphoproliferative disorders, sarcoidosis, Sjögren's syndrome, and tuberculosis. Thoughtful analysis and diagnostic work-up are required to confirm the diagnosis. Sarcoidosis is a rare systemic disease, with ocular involvement being still rarer. Here, we report a case of a young male presenting with nodular swelling over lateral aspects of both the eyes. The imaging study revealed bilateral lacrimal gland enlargement. Further work-up revealed mediastinal and hilar lymphadenopathy with pulmonary nodules which along with biochemical tests lead to the diagnosis of sarcoidosis. The case highlights the ocular symptoms in sarcoidosis and clinicoradiological approach to bilateral lacrimal gland enlargement.

Keywords: Inflammation; lacrimal gland; sarcoidosis.

Figure 1

Contrast-enhanced computed tomography showing bilateral lacrimal gland enlargement (white arrows) on both axial (a) and coronal (b) planes

Figure 2

Chest radiograph showing bilateral hilar enlargement with reticulonodular pattern in parahilar regions

Figure 3

Computed tomography chest in mediastinal window showing multiple enlarged, homogenous lymph nodes in bilateral hilar and mediastinal regions (asterisks), in axial (a) and coronal (b) planes. Note was made on small subcutaneous nodules in the right anterior chest wall (white arrow)

Figure 4

(a) Axial and (b) Coronal sections of CT chest in lung window showing multiple bilateral parahilar peribronchovascular and perifissural nodules (white arrows)

Figure 5

Differential diagnosis of bilateral lacrimal gland enlargement in a tabulated form with their key features