A 30-year-old Caucasian male with no significant past medical history was referred to our service for a choroid melanoma in the left eye (LE) in November 2005.
Since August 2005, the patient perceived a unilateral decrease in visual acuity (VA) in the left eye.
One month ago she complained of eye pain in that eye.
The right eye (RE) was 10/10 with a spherical correction of -0.5 D, the left eye was <1/10 without correction and 8/10 with spherical correction over the left atrium-5.
The mentally ill patient of the right eye showed no particularity.
The examination of the cleft lip showed a marked ciliary injection, a mild inflammatory reaction in the anterior chamber and a bulging iris; the ocular pressure (TO) was 17 mmHg.
At the bottom of the left eye, a circumscribed amelanotic mass was present in the nasal sector.
Ultrasound showed thickening of the ocular wall exceeding 5 mm. A hypoechogenic zone was observed in the extrascleral space.
With fluorescein angiography and indocyanine green angiography, this lesion was surrounded by well-visualized choroidal folds; no intratumoral vascular network was observed.
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An orbital-cerebral magnetic resonance imaging (MRI) confirmed nodular scleral thickening that contrasted in the intima-media layer of the left eye, with no evidence of other lesions.
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A thorough study looking for a rheumatic etiology (rheumatoid factor, antinuclear antibodies, cANCA, antiphospholipid antibodies) and an infectious etiology (PTHA, toxocarosis) was negative.
Blood calcium levels were normal: 2.39 mmol/l.
The chest X-ray was normal.
The angiotensin-converting enzyme, slightly increased: 73U/L (normal, 10-55), was compatible with a granulomatous condition, but the rest of the tests have not allowed to show other arguments in favor of sarcoidosis or tuberculosis.
Taking into account the anamnesis, clinical, angiographic, ultrasound and MRI examinations, a diagnosis of giant posterior scleritis was made.
An extrascleral biopsy was performed and the result of the histopathological examination confirmed a granulomatous scleritis compatible with sarcoidosis (absence of visible pathogens with Ziehl-N staining).
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Oral corticosteroid treatment was established at a dose of 1 mg/kg/day, progressively lowering the dose due to a good therapeutic response to 0.5 mg/kg/day at 6 months.
A local IO regimen of dexamethasone 0.1% 1 drop 3 times a day was associated to treat inflammation in the anterior chamber; and atropine 1% 1 drop 3 times a day to reduce ciliary spasm.
The control examination of the left eye at 6 months showed a VA of 10/10 with a spherical correction of +0.50 D. Ciliary injection disappeared, as was the inflammatory reaction in the anterior chamber, the crystalline lens.
At the bottom of the eye, solid raising in the nasal sector was flattened.
On ultrasound B, the total thickness of the ocular wall in the inferior sector was 2 mm thick nasally.
