A Case of Orbital Sarcoidosis with Caseating Granulomatous Inflammation

The authors report a rare case of orbital sarcoidosis with caseating granulomatous inflammation. A 55-year-old man presented with a 2-month history of progressively worsening diplopia and proptosis of the OS. Orbital CT demonstrated a diffuse orbital mass. Diagnostic anterior orbitotomy demonstrated...

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Published inOphthalmic plastic and reconstructive surgery Vol. 39; no. 5; p. e163
Main Authors Meer, Elana, Ahmad, Meleha, Pekmezci, Melike, Kersten, Robert C
Format Journal Article
LanguageEnglish
Published United States 01.09.2023
Subjects
Granuloma - diagnosis
Granuloma - pathology
Humans
Inflammation
Male
Middle Aged
Orbit - diagnostic imaging
Orbit - pathology
Orbital Diseases - diagnosis
Sarcoidosis - complications
Sarcoidosis - diagnosis
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Summary:The authors report a rare case of orbital sarcoidosis with caseating granulomatous inflammation. A 55-year-old man presented with a 2-month history of progressively worsening diplopia and proptosis of the OS. Orbital CT demonstrated a diffuse orbital mass. Diagnostic anterior orbitotomy demonstrated caseating granulomas. Infectious testing, including special stains, cultures, and polymerase chain reaction testing, were negative for infectious causes. Chest CT demonstrated the presence of hilar lymphadenopathy with bronchoscopic biopsy showing noncaseating granulomas, supporting a diagnosis of sarcoidosis. The patient achieved clinical and symptomatic improvement at 8-month follow-up on methotrexate. While sarcoidosis is typically characterized by non-necrotizing granulomatous inflammation, sarcoid granulomas with necrosis have been previously described in pulmonary histopathology. This case emphasizes the importance of a comprehensive systemic workup, keeping systemic sarcoidosis on the differential, for necrotizing granulomatous inflammation of the orbit.
ISSN:1537-2677
DOI:10.1097/IOP.0000000000002422