PURPOSE: Oculo-pulmonary diseases present with ophthalmic involvement and mediastinal lymphadenopathy, and common differential diagnosis include tuberculosis and sarcoidosis. In these patients with oculo-pulmonary involvement, there is scant data published on the etiology based on tissue diagnosis. We conducted this study to define the etiology in patients presenting with eye involvement and mediastinal lymphadenopathy, which will help to guide management.
METHODS: 40 consecutive patients with ocular manifestations and mediastinal lymphadenopathy were included, and transbronchial needle aspiration and biopsy (TBNA) of the mediastinal lymph nodes was done. TBNA was done with conscious sedation and topical anesthesia. Rapid on-site evaluation (ROSE) was used in all the cases. The samples were subject to both cytologic, histologic (if applicable), and microbiologic processing, by standard methods. Ocular manifestations were evaluated by an ophthalmologist.
RESULTS: There were 12 males (30%) and 28 females (70%). The location of lymph nodes included pre-tracheal (9), right para-tracheal (18) and left para-tracheal (8), subcarinal (19) and hilar (5). CT guided TBNA was used in 2 patients. A positive diagnosis was obtained in all the cases. The diagnoses included tuberculosis (17/40, 42.5%) and sarcoidosis (23/40, 57.5 %). No complications were noted. The ocular manifestations included panuvetis, anterior & intermediate uveitis, scleritis and kerato-conjunctivitis sicca.
CONCLUSIONS: Patients presenting with oculo-pulmonary involvement with mediastinal lympadenopathy have predominantly sarcoidosis and less commonly tuberculosis. This is the first study to define etiological diagnosis in these oculo-pulmonary syndromes, especially in the Indian subcontinent. This study shows that sarcoidosis is more common than tuberculosis, which is in contrast to prior practice, where most cases were presumed to be tuberculosis in India in the absence of accurate tissue diagnosis.
CLINICAL IMPLICATIONS: In patients presenting with ocular manifestations and mediastinal lymphadenopathy, a diagnostic strategy utilizing bronchoscopy with TBNA can lead to an accurate tissue diagnosis. Appropriate diagnosis permits adequate treatment on both ocular and pulmonary fronts.
DISCLOSURE: The following authors have nothing to disclose: Ravindra Mehta, Arjun Lakshmana Balaji, Kalpana Babu, Shantha Krishnamurthy
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