Sarcoid Uveitis

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Article summary goes here.

Disease Entity

Sarcoid Uveitis

Disease

Sarcoidosis is a systemic inflammatory disease characterized by the formation of noncaseating granulomas in affected organs, most commonly the lungs, lymph nodes, skin, and eyes. The disease was first described in 1878 by noted surgeon Sir Jonathan Hutchinson as a dermatologic disorder. It was not until 1909 that a Danish ophthalmologist, Heerfordt Christian Frederik1, described uveitis as part of the disease process. His eponymous “Heerfordt Sydrome” consisted of uveitis, parotitis and fever (uveoparotid fever) +/- facial palsy.


Etiology

While the etiology of sarcoidosis is unknown, several hypothesis regarding genetic and environmental factors have been studied. Some hypothesize that it is a clinical syndrome consisting of different diseases with different underlying etiologies. Associations between sarcoid and HLA-DRB1 and M. tuberculosis DNA are currently being evaluated.

Risk Factors

In the United States, the incidence of systemic sarcoidosis ranges from 5-40 per 100,000 population. This prevalence is 10 times greater for African Americans when compared to white Americans. African Americans are also more likely to have an acute presentation of the disease and a more severe clinical course whites.

A large retrospective chart review from the University of Illinois uveitis service indicated that in biopsy-proved sarcoidosis, African-American patients were more likely to be diagnosed as having uveitis than whites. African-Americans younger than 50 years were more likely to present with uveitis.

Several studies have noted a slight female preponderance, with most symptomatic patients being between 20-40 years old.


Pathophysiology

The exact etiology of sarcoidosis is uinknown, making it largely a diagnosis of exclusion. It is characterized by the appearance of noncaseating granulomas in affected tissue, most frequently seen in the lungs as bilateral hilar lymphadenopathy or pulmonary infiltration. Granulomas can also be seen on the skin, in the eyes, liver, spleen, salivary glands, heart, bones and nervous system. Ocular involvement occurs in approximately 25% of patients with sarcoidosis. The uveal tract is the most common site of ocular involvement by sarcoidosis.


Diagnosis

Sarcoid is a systemic inflammatory disease and can manifest itself in multiple ways. Therefore, clinical suspicion is often the driving force behind correct diagnosis. A thourough review of systems if necessary in all patients with recurrent uveitis. An individual with pumlonary or dermatologic complaints consistent with sarcoid should be further evaluated. Uveitis can also precede pulmonary symptoms by several years.

History

Clinical presentation of sarcoidosis depends on the severity and organ involved. A history of pulmonary disease in an individual with granulomatous uveitis should raise the suspicion of sarcoidosis.

Physical examination

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Signs

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Symptoms

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Clinical diagnosis

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Diagnostic procedures

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Laboratory test

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Differential diagnosis

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Management

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General treatment

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Medical therapy

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Medical follow up

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Surgery

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Surgical follow up

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Complications

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Prognosis

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Additional Resources

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References

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