A Rare Case of Sarcoidosis with Ocular and Cardiac Involvement

Abstract

Sarcoidosis is a multisystem granulomatous disease with varied clinical manifestations. The organs  affected more often are the lungs, skin and eyes with very rare manifestations in other organs. Ocular involvement is 26 to 50 percent and cardiac involvement is within 2 percent. We report a case of 33 year old female who presented to us with recurrent attacks of redness and pain in both eyes for 6 months. It was associated with headache, fever, myalgia, palpitation, hearing defect, tinnitus and menorrhagia. On  examination she had a visual acuity of 6-9 in both eyes with bilateral conjunctival congestion, perilimbal vitiligo,              granulomatous keratic precipitates, anterior chamber cells (2) and flare (1). Fundus examination of both eyes was no mal except for a sunset glow. She had sinus tachycardia with generalized lymphadenopathy, multiple hypopigmented  nodular lesions in the forearm, sensorineural hearing loss and ataxia. On USG B Scan there was bilateral mild anterior  vitritis with significant RCS thickening. FFA was normal. ESR, CRP and Troponin I levels were elevated. ECG revealed sinus tachycardia with premature supra-ventricular complexes and ST abnormality. Trans-thoracic echocardiogram showed decreased systolic function in right ventricle, increased wall thickness in left ventricle, mild stenosis and trace regurgitation of pulmonary valve. She was diagnosed with sarcoidosis with ocular and cardiac involvement and treated accordingly.  Ocular diagnosis helped in confirming the cardiac manifestation and thus helped in appropriate management.