Sarcoidosis Uveitis Mimicking the Presentation of Intraocular Lymphoma

Abstract

We aimed to report a case of sarcoidosis presenting with atypical clinical findings that mimicked intraocular lymphoma. A 73-year-old female presented with flashes and decreased vision in her left eye over a 2-week period. The patient had no previous ocular medical history. Initial fundal examination revealed vitritis (vitreous inflammation) with retinal hemorrhage and subretinal yellowish lesions in the left eye. All tests were negative for infectious causes. Serum angiotensin-converting enzyme (ACE) was normal. Flow cytometric analysis of vitreous showed a suspicious CD4⁺ T lymphoid population missing CD7 surface antigen and an elevated CD4/CD8 ratio. Chest CT showed hilar lymphadenopathy. Clinical findings to this point raised the suspicion of lymphoma. Hilar lymph node biopsy demonstrated granulomatous inflammation, confirming the diagnosis of sarcoidosis. Sarcoidosis presenting with uveitis in an elderly patient may pose a diagnostic challenge due to variable presentation and absence of diagnostic criteria. Retinitis and subretinal infiltrates can be a misleading clinical finding of sarcoidosis masquerading as an intraocular oncologic process such as lymphoma.




J Med Cases. 2019;10(1):4-7
doi: https://doi.org/10.14740/jmc3190