Panda sign: sarcoidosis

A 54-year-old woman presented to our outpatient ophthalmology clinic complaining of eye redness, severe pain and photophobia that had persisted for 1 day. Slit lamp examination revealed she was found to have large greasy-white mutton-fat keratic precipitates on the endothelial surface of her both eyes. Physical examination showed bilateral cervical lymphadenopathy and multiple tender erythematous nodular skin swellings on both shins. The patient's previous medical history did not suggest trauma, insect bite, diabetes mellitus or tuberculosis. The patient had previously received the Bacille Calmette Guérin vaccination, but tuberculin skin testing was negative. Histopathological examination of skin lesion and lymph node biopsies revealed non-caseating sarcoidal granuloma, and a chest radiograph revealed bilateral hilar lymphadenopathy. Furthermore, gallium-67 scanning showed symmetrical uptake of gallium-67 into the nasopharynx, lacrimal glands, parotid glands (i.e. panda sign, Figure 1A) and lower extremities (Figure 1B). On the basis of the clinical and histopathological findings, the patient diagnosed as having sarcoidosis. Sarcoidosis is a chronic granulomatous disease that can involve almost any organ in the body. The cause of this disease remains uncertain. However, a recent study showed that Propionibacterium acnes is highly associated with sarcoidosis¹. The signs and symptoms of sarcoidosis can vary depending on which organs are affected. Clinical and radiographic manifestations also vary widely among individual patients. The panda sign indicates lacrimal and salivary gland gallium-67 uptake and is generally associated with other disorders, including Sjögren's syndrome, tuberculosis, post-irradiation lymphoma and acquired immunodeficiency syndrome². Therefore, when the panda sign is present, clinicians should consider sarcoidosis as a possible differential diagnosis.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2uRCHgJ