A unilateral chronic conjunctivitis as onset of a systemic sarcoidosis

Purpose Introduction: Granulomatous conjonctivitis is unusual as a presenting symptom in patients suffering from Sarcoidosis. We report the case of a 48‐year‐old patient, presenting a chronic unilateral conjunctivitis and dyspnea for two years. The conjunctival biopsy led to the diagnosis of systemic sarcoidosis. Methods Case Report : A 49‐year‐old woman, came for an asymmetric bilateral eye discomfort for almost 6 months treated for a mislabeled allergic conjunctivits, with no effect. She reported an effort dyspnea for almost 2 years, with no other signs. Visual acuity was 20/20 P2. At slit lamp we found a low break up time at 4s with meibomian gland dysfunction and normal Shirmer test. A thickening of the lower conjunctival fornix at OR, with the presence of granuloma was noted, without pre‐auricular lymph node. Anterior segment examination was completely normal as intra‐ocular pressure and fundus. Results A conjunctival biopsy was performed and pathologic examination showed the presence of epithelioid granuloma and giant cell without caseous necrosis. All culture including mycobacteria, were negative. A medical check‐up confrimed systemic sarcoidosis. The patient was treated topically by steroïds. Systemic steroïds with methotrexate relay were established Conclusion Conclusion: Sarcoidosis can be, life threatening, especially by a heart affection that must be systematically tested. This clinical case shows the interest of a rigorous etiological investigation when a patient present a chronic unilateral or bilateral granulomatous conjunctivitis. The diagnosis of the sarcoidosis must be evoked and must motivate a general check‐up, especially if respiratory symptoms are associated. A biopsy may be performed to confirm the diagnosis.