Journal List > J Korean Ophthalmol Soc > v.49(6) > 1008002

You, Moon, Mun, Im, and Yoon: A Case of Sarcoidosis Presented as Multiple Conjunctival and Nasal Mucosal Nodule

Abstract

Purpose

Sarcoidosis is a noncaseating granulomatous disorder that can affect any organ. In its early phase, sarcoidosis is clinically similar to tuberculosis. We report a case of sarcoidosis diagnosed through ocular and systemic evaluations in a patient who developed multiple conjunctival nodules during antituberculous treatment for nasal mucosal nodules.

Case summary

A 37-year-old woman who had been on antituberculosis medications for 9 months because of multiple nasal mucosal nodules was referred for conjunctival hyperemia and the multiple nodules. The ocular examination revealed multiple conjunctival nodules in the upper and lower fornices. Biopsy and systemic evaluations were performed. A conjunctival biopsy specimen showed noncaseating granulomatous inflammation compatible with sarcoidosis. Laboratory tests revealed hypercalciuria and increased levels of ACE. Chest computed tomography showed bilateral hilar and mediastinal lymphadenopathy. Subconjunctival steroid injection was done for the conjunctival nodules and systemic steroid treatment was started as well. Complete resolution of conjunctival lesions was obtained.

Conclusions

In cases of chronic, multiple conjunctival and nasal mucosal nodules, sarcoidosis should be considered in the differential diagnosis.

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Figure 1.
Multiple yellowish pink-colored nodules in the nasal septum and inferior turbinate.
jkos-49-1000f1.tif
Figure 2.
Pretreatment and posttreatment anterior segment photographs of the left eye. (A&B) Multiple yellowish nodules on the lateral canthus, movable and elevated smooth nodules in the upper fornix at the initial visit. (C&D) Six months after treatment, the bulbar conjunctiva and fornix were cleared.
jkos-49-1000f2.tif
Figure 3.
Chest CT findings. (A) Multiple small nodules with some peribronchovascular distribution, confluent densities, and small branching structure in both lung. (B) Multiple small and enlarged conglomerate lymphadenopathies in left supraclavicular area, both sides of the mediastinum, subcarinal, both hilar, and both interlobar nodal areas.
jkos-49-1000f3.tif
Figure 4.
67-Ga Scan images demonstrate normal galium-67 citrate accumulation in the liver (A), both lacrimal glands, nasal cavity and bone marrow (B).
jkos-49-1000f4.tif
Figure 5.
Histologic findings show noncaseating epitheloid granuloma and composition of epithelioid histiocytes, Langerhans' cell and lymphocytes (H&E stain, ×200).
jkos-49-1000f5.tif
Figure 6.
Posttreatment chest CT demonstrate more decreased, but still remained multiple small lymphoadenopathy.
jkos-49-1000f6.tif
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