ArticlePDF Available

An Interesting Case of Bilateral Hilar Lymphadenopathy Presented with Visual Impairment

Authors:
Chandramouli MT
Chandramouli MT
Chandramouli MT
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Nandakishore Baikunje
Nandakishore Baikunje
Nandakishore Baikunje
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Sunil Kumar Yeshvanth at Nitte University
Sunil Kumar Yeshvanth
Subrahmanya Bhat at K.S. Hegde Medical Academy
Subrahmanya Bhat
Show all 6 authorsHide
Download full-text PDF
Read full-text
Download citation

Abstract and Figures

Sarcoidosis is a systemic granulomatous disease of unknown etiology. It primarily affects the lungs and lymphatics; however, the presentation is not always pulmonary. Uveitis is the presenting symptom in 5% of patients, predominantly in females. Cystoid macular edema is the most important sight-threatening sequela of ocular sarcoidosis. Histopathological evidence of noncaseating epithelioid granulomas from a biopsy is the gold standard for the diagnosis of ocular sarcoidosis. Diagnosis of sarcoidosis is made by exclusion of other causes of granulomatous disease, mainly tuberculosis and fungal infection and documentation of involvement of at least one additional organ system. The authors present a case of a patient with sarcoidosis involving lungs and eyes, who had uveitis as an initial presentation.
Figures - available from: Journal of Health and Allied Sciences NU
This content is subject to copyright.
Access to this full-text is provided by Georg Thieme Verlag KG.
Learn more
Content available from Journal of Health and Allied Sciences NU
This content is subject to copyright.
An Interesting Case of Bilateral Hilar
Lymphadenopathy Presented with
Visual Impairment
Chandramouli MT1Nandakishore Baikunje1Sunil Kumar Y2Subrahmanya Bhat K3Darshan Bajaj4
Giridhar Belur Hosmane1
1Department of Pulmonary Medicine, K S Hegde Medical Academy,
Mangalore, India
2Department of Pathology, K S Hegde Medical Academy, Mangalore,
India
3Department of Ophthalmology, K S Hegde Medical Academy,
Mangalore, India
4Department of Pulmonary Medicine, King George’sMedical
University, Lucknow, India
J Health Allied Sci
NU
2022;12:330–332.
Address for correspondence Chandramouli MT, MBBS, MD,
Department of Pulmonary Medicine, K S Hegde Medical Academy,
New Boys Hostel, KSHEMA Campus, Mangalore 575018, India
(e-mail: mouli.aims@gmail.com).
Introduction
Sarcoidosis is a multisystem chronic inflammatory disor-
der of unknown etiology, characterized pathologically by
noncaseating granulomas. It usually affects young adults
with variable clinical presentation. The lung is the more
frequently affected organ and accounts for morbidity
and mortality associated with this disease. Other organs
commonly involved include the eyes, skin, and lymph
nodes.
The incidence and prevalence of sarcoidosis vary substan-
tially, depending on the region of the world. It commonly
affects women than men. Diagnosis of sarcoidosis relies on
compatible clinicoradiological findings and is supported by
histopathological evidence of noncaseating epithelioid gran-
ulomas in involved organs, exclusion of other causes of
granulomatous disease, mainly tuberculosis and fungal in-
fection, and documentation of involvement of at least one
additional organ system.
Corticosteroids are the mainstay treatment for sarcoido-
sis. Additional immunosuppressive agents including metho-
trexate, azathioprine, mycophenolate mofetil, infliximab,
and adalimumab are used in refractory systemic sarcoidosis
and lung transplantation in advanced lung disease.
Keywords
►EBUS TBNA
►granulomatous lesion
►sarcoidosis
►uveitis
Abstract Sarcoidosis is a systemic granulomatous disease of unknown etiology. It primarily
affects the lungs and lymphatics; however, the presentation is not always pulmonary.
Uveitis is the presenting symptom in 5% of patients, predominantly in females. Cystoid
macular edema is the most important sight-threatening sequela of ocular sarcoidosis.
Histopathological evidence of noncaseating epithelioid granulomas from a biopsy is
the gold standard for the diagnosis of ocular sarcoidosis. Diagnosis of sarcoidosis is
made by exclusion of other causes of granulomatous disease, mainly tuberculosis and
fungal infection and documentation of involvement of at least one additional organ
system. The authors present a case of a patient with sarcoidosis involving lungs and
eyes, who had uveitis as an initial presentation.
published online
November 5, 2021
DOI https://doi.org/
10.1055/s-0041-1736454.
ISSN 2582-4287.
© 2021. Nitte (Deemed to be University). All rights reserved.
This is an open access article published by Thieme under the terms of the
Creative Commons Attribution-NonDerivative-NonCommercial-License,
permitting copying and reproduction so long as the original work is given
appropriate credit. Contents may not be used for commercial purposes, or
adapted, remixed, transformed or built upon. (https://creativecommons.org/
licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd., A-12, 2nd Floor,
Sector 2, Noida-201301 UP, India
Case Report
THIEME
330
Article published online: 2021-11-05
Case Report
A 59-year-old female presented with redness and blurring of
vision in both eyes for 20 days. An ophthalmic evaluation
showed panuveitis in both eyes. Physical examination and
laboratory results were unremarkable. A chest X-ray was
taken, which showed bilateral upper and midzone nodular
opacities and hilar lymph nodes. Further contrast-enhanced
computed tomography (CECT) thorax showed bilateral sym-
metrical parenchymal nodular and confluent peribronchovas-
cular opacities, perilymphatic nodules, nodular thickening of
the fissure, septa with upper lobe predominance, and bilateral
hilar and mediastinal enlarged lymph nodes (►Figs. 1 and 2).
Flexible bronchoscopy (FB) followed by endobronchial
ultrasound (EBUS) was planned and performed under mod-
erate sedation, and no endobronchial lesions were visual-
ized. Bronchoalveolar lavage (BAL) was taken and sent for
bacterial and fungal culture. EBUS showed bilateral hilar,
subcarinal, and right paratracheal nodes. EBUS-transbron-
chial needle aspiration (TBNA) and rapid on-site evaluation
(ROSE) were done from the subcarinal lymph node and sent
for cytology and GeneXpert (►Fig. 3). Mycobacterium tuber-
culosis was not detected in GeneXpert, and cytological
examination of lymph node aspirate showed noncaseating
granulomatous lymphadenitis (►Figs. 4 and 5). The BAL
culture showed no growth for both bacteria and fungus.
The serum angiotensin-converting enzyme (ACE) and calci-
um levels were normal. In the Mantoux test, no significant
induration was seen. Given the diagnosis of sarcoidosis
Fig. 1 Computed tomographic image of the chest demonstrating
hilar and subcarinal lymph nodes.
Fig. 2 Computed tomographic image of the chest demonstrating
numerous perilymphatic nodules and peribronchovascular opacities.
Fig. 3 Endobronchial ultrasound image demonstrating
transbronchial needle aspiration from subcarinal lymph node.
Fig. 4 Cytology of lymph node aspirate showing noncaseating
granuloma.
Fig. 5 Cytology of sarcoid granuloma showing Langerhans giant cell.
Journal of Health and Allied Sciences
NU
Vol. 12 No. 3/2022 © 2021. Nitte (Deemed to be Universit y). All rights reserved.
Bilateral Hilar Lymphadenopathy and Visual Impairment Chandramouli et al. 331
above, the patient was started on methylprednisolone pulse
therapy, followed by oral corticosteroids.
Discussion
Sarcoidosis is a systemic chronic inflammatory granuloma-
tous disease of unknown etiology. It usually affects young
adults with variable clinical presentation. It can affect
multiple organs to a varying extent and degree; lung
involvement is frequent, but the presentation is not usually
pulmonary. In 20 to 50% of patients, uveitis is an early
feature of sarcoidosis.1
The incidence and prevalence of sarcoidosis vary substan-
tially, depending on the region of the world; women are
commonly affected than men. Its incidence and prevalence
are estimated at 15.3 to 21.7/100,000 and 10 to 20/100,000
population, respectively.2In India, sarcoidosis is an under-
diagnosed disease.
Many patients with pulmonary sarcoidosis are asymp-
tomatic with incidental chest radiograph findings. Common
presenting respiratory symptoms include shortness of
breath, cough, and chest pain. Wheezing may be present in
patients with endobronchial involvement. Symmetrical and
bilateral hilar lymphadenopathy is a classical chest radio-
graph finding, and right hilar adenopathy may be slightly
more prominent.3The lung parenchymal findings on the
chest radiograph include diffuse reticular or ground-glass
opacities, nodular opacities, and fibrocystic changes with
mid-to-upper zone predominance. Bronchoscopic findings
of sarcoidosis include nodules, plaques, erythema, and
cobblestone appearance.4
Ocular sarcoidosis accounts for 10 to 50% of cases, includ-
ing lacrimal gland enlargement.5In A Case-Control Etiologic
Study of Sarcoidosis (ACCESS study), a prospective study,
11.8% of patients had ocular manifestations as presenting
symptoms.6Sarcoidosis is the leading cause of uveitis in
elderly patients.7In retrospective series of histologically
proven sarcoidosis, symptomatic uveitis accounts for 20 to
50%.8Sarcoid uveitis is typically bilateral (80–90%), with
anterior uveitis being the most common , accounting for 41 to
75% of sarcoid uveitis, followed by posterior, intermediate
uveitis, and panuveitis.9Panuveitis accounts for 7 to 14% of
sarcoid uveitis and is one of the most important systemic
associations in Japan and Europe.10,11
Typical sarcoid uveitis presents with mutton-fat keratic
precipitates, iris nodules (Koeppe, Busacca nodules), anterior
and posterior synechiae, band keratopathy, and glaucoma.
Posterior involvement includes vitritis, vasculitis, and cho-
roidal lesions. Cystoid macular edema is the most important
and sight-threatening consequence of sarcoid uveitis.
No treatment is required for asymptomatic patients. In
symptomatic patients, corticosteroids are the mainstay of
treatment. Additional immunosuppressive agents including
methotrexate, azathioprine, mycophenolate mofetil, inflixi-
mab, and adalimumab are used in refractory systemic sarcoid-
osis and lung transplantation in advanced lung disease.
EBUS-TBNA with ROSE has a good diagnostic yield and
assists in safe, adequate specimen sampling with rapid
results. EBUS-TBNA with or without ROSE is superior to
conventional TBNA (c-TBNA) without ROSE in the diagnosis
of sarcoidosis.12
Conclusion
Uveitis is a common extrapulmonary manifestation of sar-
coidosis, particularly in females; however, due to lack of
investigational modalities, it is underdiagnosed in India.
EBUS-TBNA is exceptionally useful in the evaluation of
mediastinal lymphadenopathy and early diagnosis of dis-
eases like sarcoidosis.
Funding
None.
Conflict of Interest
None declared.
References
1Jamilloux Y, Kodjikian L, Broussolle C, Sève P. Sarcoidosis and
uveitis. Autoimmun Rev 2014;13(08):840–849
2Crouser ED, Maier LA, Wilson KC, et al. Diagnosis and Detection of
Sarcoidosis. An Official American Thoracic Society Clinical Prac-
tice Guideline. Am J Respir Crit Care Med 2020;201(08):e26–e51
3Spagnolo P, Rossi G, Trisolini R, Sverzellati N, Baughman RP, Wells
AU. Pulmonary sarcoidosis. Lancet Respir Med 2018;6(05):
389–402
4Sk S, Alladi M. Sarcoidosis in India: not so rare!. J Indian Acad Clin
Med 2004;5(01):12–21
5Drent M, Costabel U. European respiratory monograph 32: sar-
coidosis. European Respiratory Society 2005. Doi: 10.1183/
1025448x.erm3205
6Baughman RP, Teirstein AS, Judson MA, et al; Case Control
Etiologic Study of Sarcoidosis (ACCESS) research group. Clinical
characteristics of patients in a case control study of sarcoidosis.
Am J Respir Crit Care Med 2001;164(10 Pt 1):1885–1889
7Grégoire M-A, Kodjikian L, Varron L, Grange J-D, Broussolle C, Seve
P. Characteristics of uveitis presenting for the first time in the
elderly: analysis of 91 patients in a tertiar y center. Ocul Immunol
Inflamm 2011;19(04):219–226
8Khanna A, Sidhu U, Bajwa G, Malhotra V. Pattern of ocular
manifestations in patients with sarcoidosis in developing coun-
tries. Acta Ophthalmol Scand 2007;85(06):609–612
9Rothova A, Alberts C, Glasius E, Kijlstra A, B uitenhuis HJ, Breebaart
AC. Risk factors for ocular sarcoidosis. Doc Ophthalmol 1989;72
(3-4):287–296
10 Barisani-Asenbauer T, Maca SM, Mejdoubi L, Emminger W, Mac-
hold K, Auer H. Uveitis- a rare disease often associated with
systemic diseases and infections- a systematic review of 2619
patients. Orphanet J Rare Dis 2012;7:57
11 Ohguro N, Sonoda KH, Takeuchi M, Matsumura M, Mochizuki M.
The 2009 prospective multi-center epidemiologic survey of uve-
itis in Japan. Jpn J Ophthalmol 2012;56(05):432–435
12 Madan K, Dhungana A, Mohan A, et al. Conventional transbron-
chial needle aspiration versus endobronchial ultrasound-guided
transbronchial needle aspiration, with or without rapid on-site
evaluation, for the diagnosis of sarcoidosis: a randomized con-
trolled trial. J Bronchology Interv Pulmonol 2017;24(01):48–58
Journal of Health and Allied Sciences
NU
Vol. 12 No. 3/2022 © 2021. Nitte (Deemed to be University). All rights reserved.
Bilateral Hilar Lymphadenopathy and Visual Impairment Chandramouli et al.332
ResearchGate has not been able to resolve any citations for this publication.
Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline
Article
Full-text available
  • Apr 2020
Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability. Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality. Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
View
Conventional Transbronchial Needle Aspiration Versus Endobronchial Ultrasound-guided Transbronchial Needle Aspiration, With or Without Rapid On-Site Evaluation, for the Diagnosis of Sarcoidosis: A Randomized Controlled Trial
Article
Full-text available
  • Feb 2017
BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as a standalone modality is superior to conventional TBNA (c-TBNA) for the diagnosis of sarcoidosis. However, the overall yield is not different if combined with endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB). The utility of rapid on-site evaluation (ROSE) in a comparative evaluation of EBUS-TBNA versus c-TBNA for the diagnosis of sarcoidosis has not been previously evaluated. METHODS: Eighty patients with suspected sarcoidosis were randomized 1:1:1:1 into 4 groups: c-TBNA without ROSE (TBNA-NR), c-TBNA with ROSE (TBNA-R), EBUS-TBNA without ROSE (EBUS-NR), and EBUS-TBNA with ROSE (EBUS-R). EBB and TBLB were performed in all patients. Primary objective was detection of granulomas for combined procedure. Secondary objectives were individual procedure yields, sedation dose, and procedure duration. Patients without a diagnosis following c-TBNA subsequently underwent EBUS-TBNA. RESULTS: A total of 74 patients were finally diagnosed with sarcoidosis. Overall, granuloma detection was not significantly different between the 4 groups (68% in TBNA-NR, 89% in TBNA-R, 84% in EBUS-NR, and 83% in EBUS-R groups, P=0.49). The yield of c-TBNA in the TBNA-NR group was lower compared with that in TBNA-R group and EBUS-TBNA in EBUS groups (32%, 72%, 68%, and 67% for TBNA-NR, TBNA-R, EBUS-NR, and EBUS-R groups, respectively, P=0.04). Additional 20% patients were diagnosed when EBUS-TBNA was performed following a nondiagnostic bronchoscopy procedure in the TBNA-NR group. Sedation requirement and procedure duration were significantly lower with c-TBNA as compared with EBUS-TBNA (P<0.001). CONCLUSION: When performing TBNA in the setting of suspected sarcoidosis, we found c-TBNA with ROSE and EBUS-TBNA (with or without ROSE) to be superior to c-TBNA alone. Whether c-TBNA with ROSE is equivalent to EBUS-TBNA cannot be determined from our study due to small sample size/low power.
View
Uveitis- a rare disease often associated with systemic diseases and infections- a systematic review of 2619 patients
Article
Full-text available
  • Aug 2012
  • ORPHANET J RARE DIS
Background Uveitis is an autoimmune disease of the eye that refers to any of a number of intraocular inflammatory conditions. Because it is a rare disease, uveitis is often overlooked, and the possible associations between uveitis and extra-ocular disease manifestations are not well known. The aim of this study was to characterize uveitis in a large sample of patients and to evaluate the relationship between uveitis and systemic diseases. Methods The present study is a cross-sectional study of a cohort of patients with uveitis. Records from consecutive uveitis patients who were seen by the Uveitis Service in the Department of Ophthalmology at the Medical University of Vienna between 1995 and 2009 were selected from the clinical databases. The cases were classified according to the Standardization of Uveitis Nomenclature Study Group criteria for Uveitis. Results Data were available for 2619 patients, of whom 59.9% suffered from anterior, 14.8% from intermediate, 18.3% from posterior and 7.0% from panuveitis. 37.2% of all cases showed an association between uveitis and extra-organ diseases; diseases with primarily arthritic manifestations were seen in 10.1% of all cases, non-infectious systemic diseases (i.e., Behçet´s disease, sarcoidosis or multiple sclerosis) in 8.4% and infectious uveitis in 18.7%. 49.4% of subjects suffering from anterior uveitis tested positively for the HLA-B27 antigen. In posterior uveitis cases 29% were caused by ocular toxoplasmosis and 17.7% by multifocal choroiditis. Conclusion Ophthalmologists, rheumatologists, infectiologists, neurologists and general practitioners should be familiar with the differential diagnosis of uveitis. A better interdisciplinary approach could help in tailoring of the work-up, earlier diagnosis of co-existing diseases and management of uveitis patients.
View
Clinical Characteristics of Patients in a Case Control Study of Sarcoidosis
Article
Full-text available
  • Nov 2001
Sarcoidosis may be affected by sex, race, and age. A Case Control Etiologic Study of Sarcoidosis (ACCESS) enrolled 736 patients with sarcoidosis within 6 mo of diagnosis from 10 clinical centers in the United States. Using the ACCESS sarcoidosis assessment system, we determined organ involvement for the whole group and for subgroups differentiated by sex, race, and age (less than 40 yr or 40 yr and older). The study population was heterogeneous in terms of race (53% white, 44% black), sex (64% female, 36% male), and age (46% < 40 yr old, 54% > or = 40 yr old). Women were more likely to have eye and neurologic involvement (chi(2) = 4.74, p < 0.05 and chi(2) = 4.60, p < 0.05 respectively), have erythema nodosum (chi(2) = 7.28, p < 0.01), and to be age 40 yr or over (chi(2) = 6.07, p < 0.02) whereas men were more likely to be hypercalcemic (chi(2) = 7.38, p < 0.01). Black subjects were more likely to have skin involvement other than erythema nodosum (chi(2) = 5.47, p < 0.05), and eye (chi(2) = 13.8, p < 0.0001), liver (chi(2) = 23.3, p < 0.0001), bone marrow (chi(2) = 18.8, p < 0.001), and extrathoracic lymph node involvement (chi(2) = 7.21, p < 0.01). We conclude that the initial presentation of sarcoidosis is related to sex, race, and age.
View
Pulmonary sarcoidosis
Article
  • Apr 2018
Sarcoidosis is a granulomatous disease of unknown cause, occurs worldwide and has a highly variable prevalence. The disease is typically dominant in the lungs, although it can affect virtually any organ and is unpredictable in its clinical course. The severity of pulmonary sarcoidosis ranges from incidentally discovered radiographic abnormalities in asymptomatic patients to a chronic progressive disease that is refractory to treatment. Mortality from sarcoidosis appears to have increased in the past three decades, with respiratory failure being the most common cause of sarcoidosis-related death. Pulmonary fibrosis, extensive disease on high-resolution chest CT, impaired lung function, and pulmonary hypertension are well established predictors of poor clinical outcomes. In patients who need systemic therapy to control their disease, corticosteroids are the most commonly used first-line treatment, with antimetabolites generally representing an alternative for patients who are unresponsive to corticosteroids or who cannot tolerate them. Indeed, corticosteroid therapy is associated with toxic effects that correlate with both the cumulative dose and duration of treatment. The scarcity of truly effective therapies and shortage of reliable predictors of the unpredictable development of disease in individual patients greatly contribute to making sarcoidosis such a difficult disease to manage.
View
Sarcoidosis in India : Not so Rare!
Article
  • Jan 2004
Sarcoidosis is a systemic inflammatory disease of unknown aetiology. In India, sarcoidosis is an under-diagnosed disease. All ethnic groups in the Indian sub-continent are affected by sarcoidosis. Most of the Indian patients with sarcoidosis are males, and a majority of them present in their fourth or fifth decade of life. Many patients with sarcoidosis are asymptomatic with incidental findings on the chest radiograph. Depending on the organ systems involved, patients with sarcoidosis present themselves to various specialities, with pulmonary involvement being the commonest. The diagnosis is based on a compatible clinical and/or radiological picture, histopathological evidence of non-caseating granulomas in tissue biopsy specimens, and exclusion of other diseases that can produce similar clinical or histopathological appearances. The disease runs a benign course with spontaneous remission of the activity. Only a minority of the patients develop complicated disease though some degree of residual pulmonary function abnormality persists. A high index of clinical suspicion and focussed attempts to secure histopathological confirmation of the diagnosis early in the illness are required to ascertain the diagnosis. For asymptomatic patients with pulmonary sarcoidosis, no therapy is required. In symptomatic patients, or those with complications, corticosteroids remain the mainstay of treatment and sometimes steroid-sparing alternative treatments may be beneficial. Treatment should be tailored to suit the needs of the individual patient under close clinical monitoring.
View
Sarcoidosis and uveitis
Article
  • Apr 2014
Uveitis is a frequent (20-50%) and early feature of sarcoidosis. Typical sarcoid uveitis presents with mutton-fat keratic precipitates, iris nodules, and anterior and posterior synechiae. Posterior involvement includes vitreitis, vasculitis, and choroidal lesions. Cystoid macular edema is the most important and sight-threatening consequence. Histologic proof from a biopsy is the gold standard for the diagnosis of ocular sarcoidosis An international workshop has recently established diagnostic criteria for sarcoidosis uveitis when biopsy is unavailable or negative: these are based on a combination of ophthalmological findings and laboratory tests. The value of recent techniques, such as PET-scan and endoscopic ultrasound-guided, fine-needle aspiration of intrathoracic nodes needs to be assessed in future studies. Corticosteroids are the mainstay treatment for sarcoidosis. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema and occlusive vasculitis. In up to 15% of cases, additional immunosuppression is used, including methotrexate, azathioprine, and mycophenolate mofetil. Infliximab and adalimumab have been recently proposed for the treatment of refractory or sight-threatening systemic sarcoidosis.
View
The 2009 prospective multi-center epidemiologic survey of uveitis in Japan
Article
  • Jul 2012
  • JPN J OPHTHALMOL
To investigate etiologic data on intraocular inflammation in Japan collected in the 2009 epidemiologic survey of uveitis in Japan and assess the current state of etiology compared with that reported in a previous survey. Thirty-six university hospitals participated in this prospective etiologic study. Patients who visited the outpatient uveitis clinic of each hospital for the first time between 1 June 2009 and 31 May 2010 were enrolled in the study. Uveitic diseases were diagnosed according to the guidelines when available or following commonly accepted diagnostic criteria. A total of 3,830 patients were enrolled in the survey and 2,556 cases of uveitis were identified, of which 1,274 cases were described as unclassified intraocular inflammation. In the identified cases, the most frequent intraocular inflammatory disease was sarcoidosis (10.6 %), followed by Vogt-Koyanagi-Harada disease (7.0 %), acute anterior uveitis (6.5 %), scleritis (6.1 %), herpetic iridocyclitis (4.2 %), Behçet's disease (3.9 %), bacterial endophthalmitis (2.5 %), masquerade syndrome (2.5 %), Posner-Schlossman syndrome (1.8 %), and retinal vasculitis (1.6 %). The current etiology of uveitis in Japan was elucidated by means of a multi-center prospective survey. Conducting such surveys on a periodic basis may help clinicians in their management of uveitis.
View
Characteristics of Uveitis Presenting for the First Time in the Elderly: Analysis of 91 Patients in a Tertiary Center
Article
To describe uveitis clinical characteristics in the elderly. Retrospective review of 91 patients at the age of 60 or more years at the authors' uveitis tertiary center over a 7-year period. Uveitis in the elderly accounted for 30.1% of this population. Uveitis localization was anterior in 22.0% of patients, intermediate in 8.8%, posterior in 20.9%, while 41.7% patients presented with panuveitis. Sarcoidosis (37.4%) and idiopathic uveitis (36.3%) accounted for the majority of cases, whereas other diagnostic entities accounted for 26.3%. Panuveitis (41.7%) and sarcoidosis (37.4%) were detected at a significantly higher frequency than in the younger population. Contrarily, ankylosing spondylitis and established ophthalmological entities (pars planitis, Birdshot chorioretinopathy, Fuchs heterochromic cyclitis) were more common in patients younger than 60 years old. In the authors' experience, sarcoidosis is the leading cause of uveitis in the elderly. Idiopathic uveitis and other specific entities account for less than two-thirds of cases.
View
Risk factors for ocular sarcoidosis
Article
  • Sep 1989
We reviewed 121 consecutive patients with biopsy-proven sarcoidosis who visited the sarcoidosis clinic of the University Hospital in Amsterdam, to determine the risk factors for the development of ocular manifestations. Of 121 patients 52 (43%) were black. Ocular disease developed in 50 (41%) patients and was more common in female and in black patients. uveitis was the most frequent manifestation of ocular sarcoidosis (29 out of 50 or 58%). There were no differences in the extra-ocular manifestations of the sarcoidosis between patients with and without ocular disease or between uveitis and non-uveitis patients. This study covered a mixed racial population and shows that different types of uveitis are seen in white and black patients. Anterior uveitis was more frequent in black patients (P less than .001), whereas posterior uveitis was more common in white patients (P less than .01). Chronic posterior uveitis with complications occurred most frequently in white female patients with late onset of the systemic disease. Uveitis was an early feature of sarcoidosis (25 out of 29 or 86%); moreover in 9 out of 29 (31%) cases, uveitis preceded the non-ocular detectable signs of sarcoidosis by more than one year. This emphasizes the importance of periodic re-evaluation of uveitis patients for sarcoidosis.
View