Paraneoplastic Ocular Sarcoid-Like Reaction in the Setting of Metachronous Pulmonary Carcinoma

Abstract

We describe a case of ocular sarcoid-like reaction (SLR) in the context of pulmonary carcinoma. A 67-year-old man in remission of two previous lung carcinomas presented with bilateral granulomatous panuveitis, disc edema and yellowish lesions in the retina’s midperiphery. Workup showed multiple hilar adenopathies, confirmed as non-necrotizing granulomas upon biopsy. Sarcoidosis with ocular involvement was assumed, but there was poor inflammation control with topical/systemic steroids. Pulmonology re-evaluation showed 2 new adenocarcinomas; the patient was started on chemo/immunotherapy. Six months later, there were no signs of inflammation, yielding the diagnosis of paraneoplastic ocular/ganglionic SLR. SLR is an immune-mediated reaction with rare ocular involvement. This case is noteworthy as the ocular SLR was the first manifestation of the two new lung adenocarcinomas in a patient in remission from two previous lung carcinomas. Controlling inflammation in these cases is achieved through treatment of the underlying neoplasia.