Background and objective: Our goal was to analyze the epidemiological and clinical findings, as well as the diagnostic approach in a group of patients in whom uveitis was the first manifestation of sarcoidosis.
Patients and method: Retrospective study (between March 1998 and July 2002) including 31 patients diagnosed with sarcoidosis after an episode of uveitis. The group consisted of 19 females (61%) and 12 males (39%). Mean follow-up was 34.5 months. Age, sex, ocular and systemic clinical findings were recorded. Angiotensin converting enzyme (ACE) levels were measured and radiological studies of the thorax were conducted including simple radiography (Rx), computerized axial tomography (CT) and gallium scan (67Ga). Biopsy was carried out in 14 patients.
Results: Mean age was 59.6 years. Six different clinical presentations of uveitic sarcoidosis were observed, the most common being bilateral panuveitis in 13 patients (42%) and chronic anterior bilateral uveitis in 11 (35%). Gallium scan, thoracic CT and chest radiography were positive in 88%, 77% and 33% cases, respectively. ACE levels were raised in 7 of the 27 patients analyzed (26%). Histological confirmation of disease was obtained in all 14 patients biopsied with a specificity and sensitivity of 100%.
Conclusions: Uveitis may be the presenting manifestation of sarcoidosis, especially in women over 60 years of age. Bilateral panuveitis and chronic bilateral anterior uveitis are the most common clinical presentations. The sensitivity of gallium scan and thoracic CT is greater than simple chest radiography in diagnosing pulmonary and mediastinal lesions of sarcoidosis. The need for biopsy should be individualized in each case depending on complementary exams, age and potential morbidity of the procedure.