| Presentation preference | Oral presentation |
| Title | Bilateral Frosted Branch Angiitis Associated With Presumed Sarcoidosis: An Uncommon Challenging Presentation |
| Accept poster if oral is not possible ? | Yes |
| Purpose | To report a case of frosted-branch angiitis (FBA) associated with multisystemic changes, in a picture consistent with sarcoidosis |
| Methods | Retrospective chart review of clinical/laboratorial data, and of multimodal imaging |
| Results | A 23-year-old female presented with severe headache, polyarthralgia, and decreased vision. Ophthalmic examination revealed: VA of 20/60 (OD), counting fingers at 2m (OS); severe bilateral anterior chamber inflammation, with granulomatous KPs; bilateral optic disc edema, as well as, frosted-branch-like vascular sheathing, with diffuse perivascular hemorrhagic exudation. Sparse pre-retinal hemorrhages were also found, in addition to multiple yellowish supravenular exudates bilaterally, consistent with “candle-wax drippings”. Lumbar puncture revealed elevated opening pressure and lymphocytic pleocytosis. CNS imaging indicated intracranial hypertension, while serologies/rheumatologic markers were non-specific. Infectious causes were ruled out, and sarcoidosis was suspected based on ocular presentation, despite absence of pulmonary findings/biopsy confirmation at that stage.
Treatment with pulse intravenous methylprednisolone, followed by cyclophosphamide, led to visual improvement. Retinal hemorrhages resolved in a month, but vascular changes/macular ischemia persisted. Adalimumab therapy was initiated, and peripheral ischemia required laser. At three months, VA improved to 20/25 in OD and 20/80 in OS, with stable imaging findings and no active intraocular or systemic inflammation
|
| Conclusion | FBA may be rarely associated with sarcoidosis, possibly paralleling severe systemic/CNS inflammation and thus requiring aggressive anti-inflammatory/immodulomodulatory therapy |
| Conflict of interest | No |
1
| Last name | FREIRE |
| Initials of first name(s) | BCC |
| Department | HOSPITAL SÃO GERALDO |
| City | BELO HORIZONTE |
| Country | Brazil |
2
| Last name | ROCHA |
| Initials of first name(s) | ACH |
| Department | Hospital São Geraldo/HC da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil |
| City | Belo Horizonte |
| Country | Brazil |
3
| Last name | AZEVEDO |
| Initials of first name(s) | DOM |
| Department | Hospital São Geraldo/HC da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil |
| City | Belo Horizonte |
| Country | Brazil |
4
| Last name | TANURE |
| Initials of first name(s) | LA |
| Department | Hospital São Geraldo/HC da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil |
| City | Belo Horizonte |
| Country | Brazil |
5
| Last name | LARA |
| Initials of first name(s) | CM |
| Department | Hospital São Geraldo/HC da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil 2 Fac |
| City | Belo Horizonte |
| Country | Brazil |
6
| Last name | ROCHA |
| Initials of first name(s) | EA |
| Department | 1 Hospital São Geraldo/HC da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil |
| City | Belo Horizonte |
| Country | Brazil |
7
| Last name | VASCONCELOS-SANTOS |
| Initials of first name(s) | DV |
| Department | 1 Hospital São Geraldo/HC da UFMG / Faculdade de Medicina da UFMG, Belo Horizonte, Brazil |
| City | Belo Horizonte |
| Country | Brazil |
