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Case Reports
. 2023 Apr 29:30:101851.
doi: 10.1016/j.ajoc.2023.101851. eCollection 2023 Jun.

A case of oculocutaneous sarcoidosis

Sadhana Sharma  1 , Ranju Kharel  1 , Sanket Parajuli  2 , Saket Jha  3 , Sudip Parajuli  4
Affiliations
Case Reports

A case of oculocutaneous sarcoidosis

Sadhana Sharma et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To present a case of extrapulmonary sarcoidosis presenting with ocular and cutaneous involvement.

Observations: We report a 54-year-male who presented with bilateral redness of eyes, photophobia, and diminished vision for a week. The best corrected visual acuity in the right eye was 6/60 and the left eye was counting fingers close to face (CFCF). He also had multiple brown plaques on the nape of the neck, chest, back, and arms. Furthermore, he was on multiple antipsychotic drugs for schizophrenia for 3 years. Uveitis investigation workup revealed raised serum angiotensin converting enzyme (ACE), negative Mantoux, and other serological tests. The patient was treated for acute anterior uveitis secondary to sarcoidosis. Clinical improvement was seen after a few days following treatment. The patient presented a year later with multiple yellowish conjunctival nodules in the superior bulbar conjunctiva associated with hyperemia. A biopsy of the plaque like skin lesions was done, which suggested cutaneous sarcoidosis. Involvement of the skin and the eyes raised suspicion that the persistent psychotic episodes despite multiple antipsychotic drugs could be attributed to neurosarcoidosis. However, magnetic Resonance Imaging (MRI) of the brain and orbit showed normal findings. After treatment with corticosteroids and immunosuppressives (methotrexate), the conjunctival nodules as well as skin lesions drastically improved, and the psychosis also responded well to clozapine.

Conclusion: A high index of suspicion is needed in cases presenting with granulomatous uveitis with multisystem involvement. Long-term follow-up is crucial to monitor the disease progression and adverse effects of medications.

Keywords: Oculocutaneous sarcoidosis; Sarcoidosis.

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Conflict of interest statement

All authors have no financial disclosures.

Figures

Fig. 1
Fig. 1
Circumcorneal congestion and mutton fat KPs.
Fig. 2
Fig. 2
Multiple, brownish plaques on chest, back at presentation and resolving lesions after treatment.
Fig. 3
Fig. 3
Multiple yellowish conjunctival nodules infiltrating the superior bulbar conjunctiva and extending to the fornix in both eyes at presentation and resolved lesions after treatment.
Fig. 4
Fig. 4
Histopathology showing noncaseating granuloma.
See this image and copyright information in PMC

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