Review for Disease of the Year: Immunopathogenesis of Ocular Sarcoidosis

[Sarcoid granuloma of the iris (clinical cases and state of the problem)]

Granulomatous lesion of the iris has varying etiology, but in the differential diagnostic it should often be considered by sarcoidosis and tuberculosis damage.

PURPOSE

To describe a clinical case of sarcoid lesion of the iris and provide an analysis of literature devoted to this problem in the context of its polyetiology.

MATERIAL AND METHODS

The article describes one case of sarcoid granuloma of the iris in a young patient with a relapsing course of the disease.

RESULTS

The presented clinical case demonstrates the need for differential diagnosis to clarify the causes of the disease and the possibility of recurrence involving appearance of a multifocal lesion. The article also reviews literature on this problem reflecting the polyetiological nature of granulomatous lesions of the iris, and argues the use of interventional diagnostic methods in the absence of extraocular pathology.

CONCLUSION

Analysis of the clinical case and literature clearly demonstrates the need for differential diagnosis of granulomatous lesions of the iris.

[Ocular sarcoidosis as a clinical manifestation of multiorgan involvement]

Eye lesion in sarcoidosis is often the first and only sign of a disorder, which suggests a possible systemic disease. Currently sarcoidosis is considered a multisystemic granulomatous disease that requires multidisciplinary approach.

PURPOSE

To study the prevalence and clinical aspects of sarcoidosis eyes based on the representative sample of patients diagnosed with extraocular nonspecific granulomatous disease.

MATERIAL AND METHODS

The study included 417 patients with multi-organ sarcoidosis. Females prevailed in the study population (259 patients - 62.11%); average patient age was 43.5±3.5 years.

RESULTS

Patients with systemic signs of sarcoidosis had an eye lesion in 7.7% of cases. Females (71.87%) at the age of 48.5±2.5 were diagnosed with sarcoidosis more often. Among the clinical forms of sarcoidosic eye lesion, anterior uveitis prevailed (59.37%), affection of the posterior uveal tract was observed less often (31.25%); the disease had chronically recurrent course in 53.12% of patients. Among rare disease forms, orbital granuloma was found in two patients, and one patient had sarcoidosis of the skin of the medial angle of the eye.

CONCLUSION

Analysis of the clinical material revealed the occurrence rate of eye lesion in patients with systemic manifestations of sarcoidosis, and gave insight on the polymorphism of clinical signs of organ lesion in multiorgan and isolated granulomatous inflammation.

[Sarcoidosis and uveitis : An update]

Ocular involvement in sarcoidosis is present in up to one third of patients and is frequently manifested before the underlying systemic disease has been diagnosed. With a view to the therapeutic consequences an early diagnosis of the underlying disease is advantageous. In cases of visual loss early diagnostic measures include invasive procedures, such as ultrasound-guided bronchoalveolar lavage and transbronchial biopsy, if nodular conjunctival or cutaneous manifestations which would confirm the diagnosis are not present. Sufficiently sensitive biomarkers of disease activity have not yet been identified. As elevated activity of angiotensin-converting enzyme (ACE) and lysozyme are associated with disease activity they may be supportive of but not specific for the diagnosis. Other indicators include calcemia, calciuria, augmented activity of hepatic enzymes, cutaneous anergy and hilar changes in the lungs. In patients with newly diagnosed anterior uveitis presenting with granulomatous mutton-fat corneal precipitates, snow balls and vitreous body base condensates with mild retinal periphlebitis in intermediate uveitis as well as multifocal choroiditis (creamy choroidal lesions at different stages of activity and approximately 500 µm in diameter), a diagnosis of sarcoidosis has to be considered and tuberculosis should be excluded, even in the absence of a known systemic disease. Anterior uveitis is frequently a self-limiting condition, which can be well-controlled with topical steroids. On the other hand, intermediate, posterior and panuveitis are typically associated with a chronic course and require systemic therapy to prevent severe loss of vision. If the response to systemic corticosteroids is insufficient, treatment with immunomodulatory agents and biologics is initiated at progressively earlier stages, with a view to averting permanent organ damage and frequently with a positive impact on the short and long-term outcomes, even in therapy-refractive cases.

Sarcoidosis in tuberculosis-endemic regions: India

Sarcoidosis is a multisystem inflammatory disease of unknown etiology affecting multiple organs. Earlier reports suggested that sarcoidosis was a disease of the developed world. However, recent reports suggest that the disease is found in the developing countries as well. Clinical, radiological, and histopathological similarities with tuberculosis pose a great challenge in countries endemic for tuberculosis. Mantoux test, high resolution computed tomography, and transbronchial lymph node and lung biopsies are diagnostic modalities, which play an important role in the diagnosis of sarcoid. In this review, we look at the epidemiology of sarcoid in tuberculosis-endemic regions, the sarcoidosis-tuberculosis link, clinical profile, diagnostic modalities, dilemma in the diagnosis, and the treatment of this disease.