Bilateral papillitis and vitritis as the initial ophthalmologic finding in a patient with complex medical history, leading to diagnosis of multisystem sarcoidosis

Aim: To report a case of bilateral papillitis as the initial ophthalmologic presentation in a patient with complex medical history and multisystemic symptoms, eventually revealing a diagnosis of sarcoidosis. Methods: Retrospective interventional case report. Report: A 54-year-old Caucasian woman presented with bilateral decreased vision, photophobia and eye pain for a month. She was referred for evaluation of disc edema with questionable history of vitritis. She had a complicated medical history and systemic symptoms, including: multiple tick bites; focal neurologic symptoms including tingling, headache, numbness of fingers, and stiff neck; systemic immune disease with thyroid nodule; and chest strain, mild shortness of breath, and palpitations, leading to a large differential diagnosis. Further workup ruled out infectious diseases and multiple sclerosis. After chest imaging, she was finally diagnosed via biopsy with sarcoidosis. Therapy included combined high dose prednisone taper and ongoing methotrexate. Both ocular and systemic symptoms improved after treatment, but there was limited improvement of scotoma in the left eye. Conclusion: This report provides a case for ophthalmologists for papillitis as the initial manifestation of sarcoidosis, but with various potential differential diagnoses during work up. : This case highlights a 54-year-old woman with papillitis who presented with a complicated history and wide variety of systemic symptoms, creating a large differential diagnosis and challenging work up, ultimately resulting in a diagnosis of sarcoidosis via biopsy. The authors feel that papillitis is an underappreciated feature of ocular sarcoid. Keywords: Papillitis, Sarcoidosis, Differential diagnosi