Optic disc granuloma with epididymitis: a diagnostic challenge

BACKGROUND: Sarcoidosis and tuberculosis (TB) share epidemiological, immunological, and molecular features common to both, and often, it becomes difficult to differentiate them especially in a highly TB-endemic country like India. We report a case of optic disc granuloma along with epididymitis and infertility in a male who showed a response to treatment with anti-tuberculosis therapy and steroids. RESULTS: A 35-year-old Indian male who presented with complaints of blurring vision in the right eye for 6 months and treated elsewhere with two intravitreal injections of anti-VEGF was found to have optic disc granuloma in the right eye. His investigations revealed highly positive Mantoux test, negative QuantiFERON test, elevated serum ACE, and HRCT of chest showing features of sarcoidosis. He also gave a history of primary infertility. Ultrasound Doppler of the scrotum was suggestive of epididymitis. After getting a chest physician opinion, the patient was started on the first line of ATT followed by oral steroids. On subsequent follow-up visits, the patient showed resolution of lesions along with the return of fertility. CONCLUSIONS: The index case of optic disc granuloma along with epididymitis had features of both tuberculosis and sarcoidosis and falls in the gray zone of tuberculous sarcoidosis and showed a response to both ATT and corticosteroids. We report this case report for its unique presentation.