97th DOG Annual Meeting 1999
P78
KERATOCONJUNCTIVIS AS FIRST MANIFESTATION OF SARCOIDOSIS IN CHILDHOOD
M. Hacker, K. Vanselow, C. Rosenkranz, A. Zubcov-Iwantscheff, N. Stärk
Background: Sarcoidosis is a granulomatous multisystem disease which seldom presents in the pediatric age group. Ocular manifestations of sarcoidosis have been reported to be the second most frequent manifestation.
Case report: A 3 4/12 old boy was hospitalized with redness and photophobia of the eyes for the last year. Visual acuity was in the right eye 6/24 and 1/6 in the left eye (SGT). He did not have any other general symptoms like cough, sweats, fever, weight loss or shortness of breath.
Examination under anesthesia showed conjunktival injection, follicular swelling, circular stromavascularisation reaching the central cornea and corneal opacity (L>R). Biopsy of conjunctiva showed the typical feature of the sarcoid granuloma. Immun-histochemistry was negative for tuberculosis. The pediatric examination showed enlarged hilar adenopathy, consistent with diagnosis sarcoidosis stage I. Serum level of ACE was above normal.
Because of the well known spontaneous remission rate of sarcoidosis stage I only local therapy with cyclosorine a tid in combination with local steroid bid was instituted. After ten weeks visual acuity improved in the right eye to 0.7, in the left eye to 0.6 (Allen chart). the slit lamp exam of both eyes showed a markedly reduced vaskularisation and stroma opacity.
Conclusion: In the differential diagnosis of chronical keratoconjunctivitis in childhood sarcoidosis should be excluded by conjunctival biopsy. Topical cyclosporin A is a potent and low risk therapy.
Department of Ophthalmology, Johann Wolfgang Goethe, University Hospital, 60590 Frankfurt/Main, Germany
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