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TitleAn optic nerve head granuloma: the first sign of a systemic disease
PurposeTo report the case of a patient who had an optic nerve head mass revealing a systemic disease and to describe the OCTA findings.
MethodsA 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.
ResultsAt 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.
ConclusionGranuloma 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.
Conflict of interestNo
Authors 1
Last nameCHAPELLE
InitialsAC
DepartmentCentre Hospitalier Universitaire du Sart-Tilman
CityLiège
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