Concurrent intermediate uveitis and an enhancing intracranial lesion as the initial manifestation of sarcoidosis

Abstract

Introduction: Posterior segment involvement has been described to be associatend with central nervous system involvement in sarcoidosis as a result of direct sarcoid tissue infiltration or mass effect of a cerebral lesion. However, isolated intermediate uveitis occurring concurrently with central nervous system involvement prior to extensive systemic disease is rare. Clinical Picture: We describe a patient with neuro-ophthalmic manifestations of intermediate uveitis and an enhancing basal ganglia lesion at initial presentation, in the absence of extensive systemic disease. Treatment: He was treated with high-dose systemic steroids which was progressively tailed down over 6 months. Outcome: There was prompt resolution of vitritis with good preservation of visual acuity. Conclusion: The difficulties of the initial diagnosis of sarcoidosis and the indications for initiation of steroid therapy are illustrated. We use this case to emphasise the need for a high clinical suspicion of sarcoidosis in the presence of similar unusual and seemingly unrelated combinations of neurological manifestations so as to facilitate the prompt institution of appropriate treatment when indicated.