Ocular Surface Reconstruction With Amniotic Membrane In A Pediatric Sarcoidosis Case Atypical Presenting With Keratitis

Sarcoidosis is a multisystem granulomatous disease of unknown etiology, characterized histologically by non-caseating granulomas. The presentation of sarcoidosis varies by age group, but in pediatric cases, it is more commonly associated with skin rashes, ocular involvement such as uveitis, and joint inflammation. We present a pediatric sarcoidosis case with atypical ocular involvement, manifesting primarily as severe keratitis and bulbar conjunctival granulomas. Our aim is to highlight the importance of early diagnosis and a multidisciplinary approach for preventing vision loss and managing systemic progression in pediatric patients with sarcoidosis.

Cam and Sakura Cıty Hospital Cornea Department, collaborating Dermatology and Pulmonology Departments.

A 16-year-old male presented with complaints of redness, pain, and photophobia in his left eye for approximately one week. The patient had no known medical conditions, regular medications, history of ocular surgery, or contact lens use, and had no recent history of swimming in the sea or a pool. Examination revealed nonpruritic papulonodular skin lesions on the arm and abdomen, marked conjunctival hyperemia, bulbar conjunctival nodules, and severe corneal involvement (edema, 6×5 mm epithelial defect, 360° vascularization, keratitis, and hypopyon). Microbiological cultures grew Streptococcus oralis and Rothia mucilaginosa. Laboratory tests showed elevated angiotensin-converting enzyme (ACE) levels, and imaging demonstrated bilateral hilar lymphadenopathy. A preliminary diagnosis of sarcoidosis was made, supported by dermatological and pulmonological consultations. Skin biopsy confirmed granulomatous dermatitis consistent with sarcoidosis.

Topical antibiotics, fortified eye drops, oral doxycycline, and topical steroids were initiated. Repeated amniotic membrane transplantation was performed for ocular surface reconstruction. Systemic corticosteroids (1–2 mg/kg/d) were added, leading to regression of conjunctival granulomas, resolution of hypopyon, and improved corneal findings. Visual acuity increased to 0.6 in the right eye and 0.3 in the left eye. Follow-up continues with a multidisciplinary team to monitor both ocular and systemic manifestations.

Sarcoidosis, although uncommon in children, can present with severe ocular surface disease and granulomatous conjunctival lesions. Early recognition and coordinated management involving ophthalmology, dermatology, and pulmonology are essential to prevent permanent vision loss.  This case underscores the need to consider sarcoidosis in pediatric patients with atypical keratitis and cutaneous granulomas. Amniotic membrane transplantation may be considered to treat the ocular surface in these patients.