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A 31-year-old African-American woman was referred for a one-year history of worsening vi­sion in both eyes associated with pressurelike pain and photophobia. Her corneas were notable for 4+ “mutton-fat” granulomatous keratic precipitates diffusely distributed in the right eye (see image) and 2+ similar findings in the left. Koeppe and Busacca iris nodules were also noted in both eyes. The vitreous contained 2+ active inflammatory cells in both eyes but periph­eral inflammatory snowballs were noted only in the right.

The patient had been diagnosed with optic neuritis 10 years prior and subsequent workup led to a diagnosis of multiple sclero­sis, which was controlled on Copaxone (glatiramer acetate). While bilateral granulomatous panuveitis has been associated with MS, we decided to proceed with a sarcoidosis workup. Initial lab data revealed a mildly elevated serum level of lysozyme (21 µg/ml), but angiotensin-converting enzyme levels were normal, and a CT scan of the chest did not reveal hilar adenopathy.
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