La Revue de médecine interne
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Uveitis is a common (20-50%) and early manifestation of sarcoidosis. Typical sarcoid uveitis presents with bilateral mutton fat keratic precipitates, iris nodules, and anterior and posterior synechia. Posterior involvement includes vitreitis, vasculitis and choroidal lesions. ⋯ Systemic corticosteroids are indicated in uveitis not responding to topical corticosteroids or in the presence of bilateral posterior involvement, especially with macular edema and occlusive vasculitis. In 5 to 20% of the patients who are corticosteroids resistant or require an unacceptable dose to maintain remission, additional immunosuppression is used, including methotrexate, leflunomide and mycophenolate mofetil. As in systemic sarcoidosis, infliximab has been recently suggested for refractory or sight threatening disease.
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Sarcoidosis is a multisystemic granulomatosis of unknown cause that predominantly affects the lung and the lymphatic system, especially intrathoracic. The diagnosis relies on the association of a compatible clinical and radiological presentation, the presence of characteristic histopathological lesions (non-necrotizing epithelioid granuloma with giant cells) and the exclusion of other potential causes of granuloma. ⋯ Severe complications of the pulmonary disease include stage IV sarcoidosis, pulmonary hypertension, bronchial stenosis and pulmonary aspergillosis. In-depth knowledge of pulmonary sarcoidosis is required to ensure the diagnosis of this non-rare disorder of multiple presentation, to identify potentially severe cases and to guide therapeutic decision.