Sarcoidosis with Optic Disc Inflammatory Mass, Subretinal Fluid, and Maculoschisis

Fundus images of a 29 year old black man who had a history of hilar adenopathy confirmed by CT scan, had been hospitalized for pulmonary inflammatory disease, had cutaneous lesions, and now presented with spots and blurred vision of the right eye over 2 weeks. Visual acuity was 20/40 right eye, 20/25 left eye. The vitreous had inflammatory cells, the disc had an inflammatory lesion, and subretinal fluid was present inferiorly. Preretinal hemorrhage is seen inferiorly. The OCT shows the subretinal fluid (yellow arrow) and also a clinically unrecognized schisis cavity extending from the disc to the macula (orange arrow). The fluorescein angiogram shows leakage of fluorescein from the disc lesion. Angiotensin converting enzyme level was 182 with the upper limit of normal being 68. The patient was treated with prednisone and cellcept.