title: Low dose corticosteroid in association with methotrexate for therapy of ocular sarcoidosis: report of a case.
abstract: Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Ocular involvement can be the initial manifestation, occurring by itself, or it can be associated with other systemic signs of sarcoidosis. A 31 years-old caucasian female presented a 10-day history of decreased vision and pain in OS. Biomicroscopy revealed fine keratic precipitates, a mild reaction in the anterior chamber and in the vitreous cavity in both eyes and a small posterior synechiae in OS. Intraocular pressure was 12 mmHg in the OD and 9 mmHg in OS. Fundoscopy disclosed mild swollen and hyperemic optic discs and some subretinal yellowish nodules of 1/3 to 1 disc diameter, partially delimited, located in the posterior pole and midperiphery in both eyes. The Chest X-ray disclosed the suspicion of hilar lymphadenopathy, especially on the left-side. The positron emission tomography (PET-scan) showed increased 18 F-fluorodeoxyglucose uptake in the paratracheal and bilateral hilar lymph nodes, indicating high local cellular metabolism. A mediastinal lymph node biopsy was performed afterwards, which depicted non-caseating granulomas with multinucleated giant cells and absence of acid-alcohol resistant bacilli. The patient was initially treated with oral prednisone 60 mg/day with slow tapering over the next months. A decreased papillitis and an increased size of the choroidal granulomas was observed after a 6-month therapy (Figs. 1B and 2B). Then, a combination of methotrexate 20 mg/week and prednisone 10 mg/day was given over the following months, which led to a gradual reduction in size and thickness of the choroidal granulomas. A weak response to steroid monotherapy was initially observed in this patient. The introduction of a non-steroid immunosuppressant drug (methotrexate) was associated with significant anatomic improvement in the following months. This report raises the suggestion that an early introduction of a nonsteroidal immunosuppressive drug to systemic steroids may be beneficial for a rapid remission of the uveitis.
authors.affiliation: Resident in Ophthalmology, Sadalla Amin Ghanem Eye Hospital, Rua Desembargador Nelson Nunes Guimarães, 811, CEP 89203060 Joinville, SC Brasil.
authors.forename: Grasiane Nunes
authors.identifier: 0000-0001-5866-4692
authors.initials: GN
authors.lastname: Mayer
authors.affiliation: University of Joinville, Rua Saí, 305, apto 704, Anita Garibaldi, CEP 89202-170 Joinville, SC Brazil.
authors.forename: Morgana
authors.initials: M
authors.lastname: Longo
authors.affiliation: University of Joinville, Rua Alexandre Schlemm, 233, apto 301, Bucarein, CEP 89202-417 Joinville, SC Brazil.
authors.forename: Bárbara Brandi
authors.initials: BB
authors.lastname: Gomes
authors.affiliation: University of Joinville, Sadalla Amin Ghanem Eye Hospital, Rua Camboriú, 35 (Eixo Marquês de Olinda), CEP 89216-222 Joinville, SC Brazil.
authors.forename: Mário Junqueira
authors.initials: MJ
authors.lastname: Nóbrega
keywords: Diagnosis of sarcoidosis; Ocular sarcoidosis; Sarcoidosis in Ophthalmology