A 25-year-old Caucasian male patient presented with a three-week history of a red right eye. He complained of blurred vision on the affected eye without pain or other sensations. He had no fever, fatigue, and denied weight loss. His past medical and family history were unremarkable.
On examination, the patient's visual acuity was 14/20 OD and 20/20 OS. A prominent vascularized iris lesion located at 7 o'clock was present in the right eye in addition to mutton-fat keratic precipitates, predominantly in Arlt's triangle, anterior chamber cells, and mixed conjunctival and ciliary injection (Figure 1(a)). Neither fundoscopy of the right eye nor examination of the left eye disclosed any pathological findings.
An ultrasound biomicroscopy (UBM) of the right eye revealed a prominent iris process with extension into ciliary body which measured 4.7 x 4.0 x 1.8 mm with middle internal reflectivity (Figure 1(b)).
Laboratory findings were unremarkable including serum ACE level and tuberculin testing. Chest computed tomography (CT) revealed bilateral hilar lymphadenopathy and reticulonodular parenchymal involvement.
To confirm the suggested diagnosis of sarcoidosis, conjunctival biopsy was performed. Histopathological work-up showed granulomatous epithelioid cell inflammation with insular central necrosis without acid-fast bacilli (Figures 1(c) and 1(d)). The diagnosis of tuberculosis was suspected and further examinations were initiated.
Extensive systemic checkup, including bronchoscopy, bronchoalveolar lavage (BAL) with CD4/CD8 ratio evaluation, and transbronchial biopsy, revealed no evidence of acid-fast organisms. Transbronchial biopsy showed noncaseating granulomatous inflammation, typical for sarcoidosis. PCR showed no mycobacterial DNA in the biopsy specimen.
Systemic and topical steroid therapy was initiated with oral prednisolone 100 mg daily and prednisolone acetate 1% eye drops hourly. Under this treatment our patient recovered completely. Eight weeks after the first presentation, no signs of intraocular inflammation were detectable, the iris tumor resolved completely, and the patient was free of any complaints.