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case_images: Axial view of magnetic resonance imaging (MRI) showed intraconal soft tissue and optic nerve sheath complex swelling [obscured the territories of different segments (Orange arrow)] (A). The positron emission tomography (PET) computed tomography demonstrated multiple fluorodeoxyglucose (FDG) avid lymph nodes above and below the diaphragm (red arrows) (B). MRI improved following the treatment [clear borders of segments (blue arrow)] (C).
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case_images: It also showed dural-based lesions along the greater wing of the right sphenoid and inferior frontal convexity with underlying cortical erosion and enhancement of the calvarium and subtle leptomeningeal enhancement along the ventral surface of the pons (Figure 1).  Positron emission tomography (PET) CT demonstrated multiple fluorodeoxyglucose (FDG) avid lymph nodes above and below the diaphragm, consistent with a diagnosis of sarcoidosis (Figure 1). Follow-up MRI showed improvement in soft tissue thickening and enhancement within the intraconal soft tissues near the orbital apex as well as the peripheral enhancement of the proximal intraorbital segment of the optic nerve sheath complex (Figure 1).
case_images: At the baseline, standard and ultra-wide color fundus photographs of the right eye had a normal appearance; however, the left eye showed disc edema with blurred margin and peripapillary chorioretinal atrophy (A-D). Although macular SD-OCT of the right eye was normal (E and F), the left eye showed preserved foveal contour but intraretinal edema (yellow arrow) and disruption of the ellipsoid zone (EZ) line (G and H). Spectral-domain optical coherence tomography (SD-OCT) through the optic disc showed elevated optic disc and subretinal fluid (red arrow) at temporal (I and J). In addition to the SD-OCT of optic disc improvement, intraretinal edema decreased in size and echogenicity (blue and Orange arrows), and the disrupted EZ line partially improved following the treatment at 2 months, 5 months, and the most recent visit (K-S).
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case_images: OD and 20/60 OS, and IOP was 9 and 10 mmHg OD and OS, respectively. Ophthalmic examination revealed disc swelling with a blurred optic nerve margin, peripapillary chorioretinal atrophy, and 1+ cell in anterior vitreous OS and unremarkable findings OD (Figure 2). Although the spectral-domain optical coherence tomography (SD-OCT) image was normal OD (Figure 2), preserved foveal contour with intraretinal edema and ellipsoid zone disruption in the macular region were detected in OS (Figure 2). Moreover, SD-OCT of the left eye optic nerve showed elevated disc and subretinal fluid at the temporal side (Figure 2). Fundus photo showed milder optic disc edema and SD-OCT manifested improvement, such as decreased size and echogenicity of intraretinal fluid OS (Figure 2). However, three months later, methotrexate was replaced with monthly infliximab infusion (7.5 mg/kg for 4 months) to manage the worsening of his neurologic symptoms, such as severe headaches as well as ocular inflammation OU (+1 anterior chamber flare and cells) (Figure 2). During the most recent visit, the patient indicated an improvement in blurriness, light sensitivity, and eye pain OU, which was in line with the resolution of ocular inflammation (no anterior chamber flare and cells) and BCVA of 20/20 and 20/30 in OD and OS, respectively (Figure 2).
case_images: Early and late phase wide-angle fundus fluorescein angiography showed window defect on chorioretinal atrophy lesions with moderate optic disc hyperfluorescence (green arrow) at baseline (A and B), which slightly improved following treatment at 2 months (C and D).
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case_images: Wide-angle fundus fluorescein angiography (FA) at the late phase showed moderate optic disc hyperfluorescence and window defect on the lesion with chorioretinal atrophy OS (Figure 3). Likewise, FA showed improvement in the optic disc inflammation as reduced hyperfluorescence (Figure 3).