A Case of Sarcoidosis Presented as Multiple Conjunctival and Nasal Mucosal Nodule

In-Cheon You; Hyung-Jin Moon; Gwi-Hyeong Mun; Sang-Chul Im; Kyung-Chul Yoon

doi:10.3341/jkos.2008.49.6.1000

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

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

Original Article

J Korean Ophthalmol Soc 2008;49(6):1000-1006.

Published online: 8 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.6.1000

A Case of Sarcoidosis Presented as Multiple Conjunctival and Nasal Mucosal Nodule

In-Cheon You, M.D.^1,, Hyung-Jin Moon, M.D.², Gwi-Hyeong Mun, M.D.², Sang-Chul Im, M.D., Ph.D.³, Kyung-Chul Yoon, M.D., Ph.D.²

¹Department of Ophthalmology, Chonbuk National University, College of Medicine Chonbuk, Korea

²Department of Ophthalmology, Chonnam National University Medical School Gwangju, Korea

³Department of Otorhinolaryngology, Chonnam National University Medical School Gwangju, Korea

Address reprint requests to In-Cheon You, M.D. Department of Ophthalmology, College of Medicine, Chonbuk National University #634-18 Geumam-dong, Dukjin-gu, Jeon-ju, Jeonbuk 560-182, Korea Tel: 82-63-250-1965, Fax: 82-63-250-1960, E-mail: you2ic@paran.com

26 February 2008 Accepted 9 November 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Conjunctiva, Corticosteroid, Nasal mucosa, Sarcoidosis

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Figure 1.

Multiple yellowish pink-colored nodules in the nasal septum and inferior turbinate.

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.

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.

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).

Figure 5.

Histologic findings show noncaseating epitheloid granuloma and composition of epithelioid histiocytes, Langerhans' cell and lymphocytes (H&E stain, ×200).

Figure 6.

Posttreatment chest CT demonstrate more decreased, but still remained multiple small lymphoadenopathy.

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