Peripheral choroidal nodules in a case of proven systemic sarcoidosis

Abstract

A case of sarcoidosis presenting as peripheral choroidal nodules has been described.

A 38-year-old female presented with complaints of floaters in both eyes for the past 7 months. Her best corrected visual acuity was 6/6 OU. Anterior segment OU was normal. Dilated fundus OU showed clusters of yellowish white, round, and subretinal lesions associated with intraretinal hemorrhages more in the superotemporal and inferotemporal fundus. This fundus picture along with bilateral hilar lymphadenopathy as visualized in high resolution computed tomography of the chest clinched the diagnosis of sarcoidosis.

Figure 1: Color fundus photograph montage of the right eye (a) and of the left eye (b) showing clusters of choroidal nodules in the superotemporal and inferior quadrants showing lesions in various stages of activity

Figure 2: Fundus fluorescein angiography montage of the right eye (a) and the left eye (b) showing multiple hyperflourescent spots corresponding to the choroidal lesions

Figure 3: High resolution computed tomography of the chest showing bilateral hilar lymphadenopathy

Discussion

Sarcoidosis is a chronic multisystemic, granulomatous disease of unknown etiology. Ocular manifestations are common in 25%-50% of patients in histologically proven disease.[¹] Although ocular sarcoidosis more commonly presents as an anterior granulomatous uveitis, a wide spectrum of ocular involvement exists. Typical posterior segment findings include vitritis with or without inflammatory “snowballs,” retinal periphlebitis, preretinal inflammatory nodules, “candle wax drippings,” and choroidal lesions.[²³]