Titel | An optic nerve head granuloma: the first sign of a systemic disease |
Doel | To report the case of a patient who had an optic nerve head mass revealing a systemic disease and to describe the OCTA findings. |
Methodes | A 66- years-old patient was referred to our neuro-ophthalmology department for a loss of vision on the right eye. He was followed for a year in a private clinic and multiple diagnosis were gradually made. Despite miscellaneous treatment, the vision kept decreasing. His previous medical history was unremarkable. |
Resultaten | At presentation, visual acuity was 4.5/10 on the right and 10/10 on the left eye. Fundus examination showed a mass on the right optic nerve surrounded by exudates and serous retinal detachment. Visual field was severely restricted. OCT revealed a swollen disc and a diffuse loss of ganglion cells. OCTA showed an abnormal vascularisation located in the choroidal level. The biology was negative (ACE, tuberculosis, ANA) whereas the pet-CT showed multiple thoracic and abdominal adenopathies. The lymph node biopsy revealed a non-necrotic granulomatous inflammation. The diagnosis of sarcoidosis was made and the patient was treated first with steroids and afterwards with lederthrexate. |
Conclusie | Granuloma is the first symptom of sarcoidosis in less than 1%. It is often misdiagnosed. A careful work-up should be done in front of patients with an optic nerve head mass. The type of vascularization could help to make the diagnosis. |
Belangenverstrengeling | Nee |
Naam | CHAPELLE |
Initialen | AC |
Instituut | Centre Hospitalier Universitaire du Sart-Tilman |
Stad | Liège |