Sarcoidosis in a 37‑year‑old woman manifested as vision loss and nasal congestion
- A 37-year-old woman experienced worsening vision and bilateral nasal congestion.
- A biopsy of the lip mucosa revealed granulomas – the diagnosis is sarcoidosis.
- Glucocorticoid therapy quickly improved her condition.
Sarcoidosis is a rare systemic disease characterized by the formation of non-caseating granulomas in various organs. The lungs, lymph nodes, skin, and eyes are most commonly affected, but upper respiratory tract involvement is less common, which can complicate timely diagnosis.
A recent report from American otolaryngologists described a case of a 37-year-old woman who experienced worsening bilateral nasal congestion and noticeably deteriorating vision over several weeks. The symptoms arose without prior trauma or infectious diseases, prompting doctors to look for less typical causes.
The patient noted that the visual disturbances manifested as a gradual loss of sharpness, accompanied by a feeling of 'blur' in both eyes. Alongside this, she complained of persistent swelling and congestion of the nasal passages, which made breathing difficult and led to frequent headaches.
Diagnostic approach
To clarify the diagnosis, the doctors conducted a comprehensive examination, including an ophthalmological examination, chest X-ray, and computed tomography of the sinuses. Since the results did not reveal characteristic changes in the lungs, a decision was made to perform a biopsy of the mucosal tissues of the lower lip, where small salivary glands are located.
Histological examination of the sample showed a significant accumulation of non-caseating granulomas, consisting of epithelioid and giant cells surrounded by lymphoid infiltrate. Such findings are typical for sarcoidosis and allowed for the exclusion of other granulomatous processes, such as tuberculosis or Wegener's granulomatosis.
After confirming the diagnosis, the patient was prescribed a glucocorticoid therapy regimen – the drug prednisone at a moderate dose. Hormonal treatment is aimed at suppressing the inflammatory process and the destruction of granulomas, which usually leads to a rapid improvement in the clinical picture.
A few weeks after starting prednisone, the woman noted a significant reduction in nasal congestion, and her visual functions were almost restored. Follow-up examinations confirmed a decrease in granulomas in biopsy samples and the absence of new lesions in the lungs.
The case highlights the importance of a comprehensive approach to patients with non-localized symptoms from the respiratory and visual systems. Early detection of sarcoidosis allows for the initiation of effective hormonal therapy, preventing possible complications and maintaining quality of life.
Source: N+1
