Systemic Disorders With Optic Nerve and Retinal Findings

A 35-year-old African-American woman had gradual bilateral painless visual loss over 3 months. When initially seen, the visual acuities were HM OD, NLP OS. The MRI showed diffused enhancement of the optic nerves and lacrimal glands. The evaluation strongly suggested sarcoidosis, with elevated angiotensin-converting enzyme (ACE) x 2, and an abnormal urinary 24-hour calcium = 650 (150-300). A chest scan demonstrated several paratracheal and hilar nodes; the gallium scan with increased uptake in the hilar nodes. The spinal tap showed a glucose of 62, protein = 37, and 3 WBC, 100% lymphs, with negative serology. Pair with 92_55.