Title |
Low dose corticosteroid in association with methotrexate for therapy of ocular sarcoidosis: report of a case
|
---|---|
Published in |
International Journal of Retina and Vitreous , June 2015
|
DOI | 10.1186/s40942-015-0006-7 |
Pubmed ID | |
Authors |
Grasiane Nunes Mayer, Morgana Longo, Bárbara Brandi Gomes, Mário Junqueira Nóbrega |
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. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 4 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Lecturer | 1 | 25% |
Other | 1 | 25% |
Student > Doctoral Student | 1 | 25% |
Student > Master | 1 | 25% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 3 | 75% |
Agricultural and Biological Sciences | 1 | 25% |