A 31 years-old caucasian female presented a 10-day history of decreased vision and pain in the OS. Examination showed visual acuity of 20/20 in OD and 20/25 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 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 (Figs. 1a and 2a).  
Serologic tests for toxoplasmosis, syphilis and acquired immunodeficiency syndrome were negative as well as skin test for tuberculosis (purified protein derivative or PPD). Serum lysozyme was 14.0 mg/L (laboratory normal range 9,6 to 17,1 mg/L) and angiotensin-converting enzyme was 87.0 IU/L (laboratory normal range 35 to 90 IU/L). The Chest X-ray disclosed the suspicion of hilar lymphadenopathy, especially on the left-side (Fig. 3). The PET-scan showed increased 18 F-fluorodeoxyglucose uptake in the paratracheal and bilateral hilar lymph nodes, indicating high local cellular metabolism (Fig. 4). A mediastinal lymph node biopsy was performed afterwards, which depicted non-caseating granulomas with multinucleated giant cells and absence of acid-alcohol resistant bacilli (Fig. 5).   
The patient was initially treated with oral prednisone 60 mg/day with gradual reduction. Six months after the treatment began the prednisone intake was 20 mg/day, when there was a decrease in papillitis and an increase in the choroidal granuloma size (Figs. 1b and 2b). At that visit a combination of methotrexate 20 mg/week and prednisone 60 mg/day was prescribed. During the following 12 months the prednisone daily dose was decreased 10 mg each visit. By the 18th month of treatment the intake of prednisone was 10 mg/day, leading to a gradual reduction in the choroidal granulomas' size and thickness and stabilized uncorrected visual acuity of 20/20 in both eyes (Figs. 1c and 2c).