PT  - JOURNAL ARTICLE
AU  - Laurence Buisseret
AU  - Nacima Kisma
AU  - Annick Massart
AU  - Frédéric D Debelle
AU  - Elie Cogan
AU  - Monique Cordonnier
TI  - Optic neuropathy, renal failure and pulmonary sarcoidosis in a 50-year-old man: where is the link?
AID  - 10.1136/bcr.05.2009.1879
DP  - 2009 Jan 01
TA  - BMJ Case Reports
PG  - bcr0520091879
VI  - 2009
4099  - http://casereports.bmj.com/content/2009/bcr.05.2009.1879.short
4100  - http://casereports.bmj.com/content/2009/bcr.05.2009.1879.full
AB  - Eye disorders are frequently associated with renal diseases, mostly linked to underlying causes such as hypertension, diabetes or autoimmune diseases. Conversely, advanced uraemic states may also lead to progressive vision impairment. The present report concerns a 50-year-old patient who presented with a bilateral, painless, progressive vision loss, a moderate systemic inflammation and chronic renal failure due to hypertension nephrosclerosis. Steroids were given and haemodialysis was initiated, resulting in vision improvement. At 4 months later when the steroids were stopped, the patient developed dyspnoea, cough, fever and fatigue of unclear origin. A lung biopsy showed non-caseating granuloma consistent with pulmonary sarcoidosis. Re-challenge with steroids rapidly improved the respiratory disease. Ophthalmological examinations performed early and later in the course excluded anterior ischaemic optic neuropathy and ocular manifestations of sarcoidosis, leading to a diagnosis of uraemic optic neuropathy. This rare ophthalmological disorder should be promptly recognised since haemodialysis and steroid therapy are highly effective.