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In this study, we present a case of bilateral optic neuropathy and macular ischemia in the right eye associated with neurosarcoidosis. A 26-year-old woman presented to our clinic with complaints of bilateral blurred vision. Bilateral granulomatous anterior uveitis, vitritis, optic neuropathy, and macular ischemia were detected in the right eye in slit-lamp examination. She also reported complaints of fever, weakness, sweating, arthralgia, and headache for 2 months. She was referred to the pulmonary diseases unit of our hospital due to hilar lymphadenopathy seen in her chest x-ray, and biopsies were taken for diagnostic purposes. Histological analysis of the mediastinal lymph node biopsies revealed chronic, non-caseating, granulomatous inflammation. Furthermore, the patient was referred to a neurologist due to concomitant complaint of intense headaches. She was diagnosed with neurosarcoidosis supported by findings on cranial magnetic resonance imaging and lumbar puncture. She received a 3-day course of high-dose (1 g/day) intravenous steroid treatment (methylprednisolone) followed by a tapering dose of oral prednisone. The patient began receiving oral methotrexate 15 mg/week as a steroid-sparing agent. Significant improvement in neurological and ophthalmological symptoms occurred in the first week of treatment. In this case report, we emphasized that neurosarcoidosis should be included in the differential diagnosis of patients with both bilateral optic neuropathy and macular ischemia. Furthermore, early diagnosis and timely treatment of neurosarcoidosis are important for favorable visual outcomes.

Sarcoidosis is a multisystem granulomatous disorder, commonly affecting young adults and usually presenting with bilateral hilar lymphadenopathy and pulmonary infiltration. Central nervous system (CNS) involvement is extremely rare. The cause of sarcoidosis is unknown. The diagnosis of sarcoidosis is firmly established when histopathological evidence of non-caseating granulomas in affected organs supports compatible clinicoradiographic findings. Here, we present a case of a 30-year-old woman referred to our clinic with amenorrhea and polyuria. The radiological appearance of a lesion involving the pituitary stalk was an image of inflammatory infiltration, which is pathognomic for sarcoidosis, syphilis, tuberculosis and foreign body granulomatosis. Laboratory tests were done to rule out syphilis and tuberculosis. A possible diagnosis was sarcoidosis. When we searched other systems for the involvement of sarcoidosis, lungs, lymph nodes, skin and eyes were not involved by the disease. Histopathological examination of a transcranial incisional biopsy revealed a non-caseating granuloma, consisting of macrophages, epithelioid cells, and multinucleated giant cells that secrete cytokines. Around this central core, CD4 and CD8 lymphocytes, B lymphocytes, plasma cells, and fibroblasts were detected. The diagnosis was neurosarcoidosis. We present this case to draw attention to the possibility of isolated neurosarcoidosis as the differential diagnosis of pituitary lesions and review recent advances in the investigation, diagnosis and treatment of this condition [ABSTRACT FROM AUTHOR]