Unmasking neurosarcoidosis in a patient with acute zonal occult outer retinopathy: a case report

BACKGROUND: We report a case of neurosarcoidosis in a patient with a prior history of acute zonal occult outer retinopathy (AZOOR), using multimodal imaging, including color fundus photography, spectral-domain optical coherence tomography, fluorescein and indocyanine green (ICG) angiography. CASE PRESENTATION: A 37-year-old female with a history of AZOOR presented with new-onset bilateral photopsia and a paracentral scotoma in the left eye. Examination revealed bilateral anterior chamber reaction, optic disc edema, vitreous cells, and choroiditis on ICG angiography. Given the presentation, AZOOR recurrence was deemed unlikely, and further workup for panuveitis was initiated. A week later, she developed multiple cranial neuropathies, and further systemic evaluation confirmed neurosarcoidosis. High-dose corticosteroids and methotrexate resolved both neurological and ophthalmic symptoms. CONCLUSIONS: This case highlights the importance of carefully evaluating patients with inflammatory eye conditions, as new symptoms might suggest a different diagnosis rather than a recurrence of the preexisting condition. Prompt recognition and adequate treatment can significantly impact patient outcomes.