Presentation
Bilateral uveitis. Raised serum angiotensin converting enzyme.
Patient Data
Chest radiograph was reported as normal.
There are multiple enlarged hilar and mediastinal lymph nodes. No lymph node calcification.
There is a 5 mm soft tissue density subpleural nodule, in the left upper lobe posteriorly. A further soft tissue density nodule is noted in the left lower lobe, measuring 8 mm in size.
There are multiple areas of ground glass opacity in the left lower lobe, with diffuse tree in bud nodularity bilaterally.
Imaging appearances are in keeping with stage II sarcoidosis. There is mediastinal and hilar lymphadenopathy. Bilateral lung nodules mainly related to the pleura, are likely sarcoid nodules.
The enlarged lymph nodes are amenable to biopsy with endobronchial ultrasound.
No abnormality was demonstrated in the imaged volume of the upper abdomen or the imaged bones.
Case Discussion
This patient's initial presentation was to ED with a painful red eye diagnosed as anterior uveitis.
He had a second presentation 3 months later with the same symptoms and was diagnosed with chronic granulomatous anterior uveitis.
Vasculitis screen including c-ANCA and p-ANCA were all negative. Serum ACE was positive at 178 (normal: 8-52). This prompted the CT chest request, findings of which are consistent with stage II sarcoidosis.
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