Elsevier

Ophthalmology

Volume 102, Issue 11, November 1995, Pages 1712-1721
Ophthalmology

Taches de Bougie

https://doi.org/10.1016/S0161-6420(95)30804-4Get rights and content

Background: Posterior segment lesions, including taches de bougie, may be the presenting sign of sarcoidosis. In patients with unrecognized sarcoidosis, taches de bougie may be misinterpreted as the lesions of birdshot chorioretinopathy (BCR) or multifocal choroiditis (MFC).

Methods: In a retrospective study, the authors identified 22 patients with taches de bougie and sarcoidosis. A tissue biopsy showed noncaseating granulomas in 17 patients. All available ophthalmic and medical records of these patients were reviewed.

Results: Two patterns of taches de bougie were observed. Sixteen patients (73%) had small, discrete white spots in the inferior or nasal periphery, indistinguishable from the lesions of MFC. In six patients (27%), larger, posterior, pale yellow-orange streaks developed that were identical to the lesions of BCR. Visual prognosis was better with posterior streaks. The chest x-ray was normal in 5 of 16 patients with peripheral spots and in 3 of 6 patients with posterior streaks. Serum angiotensin-converting enzyme was negative in 5 of 14 patients. Gallium scan showed increased hilar uptake in five patients, three of whom had a normal chest x-ray. Human lymphocyte antigen A29 was positive in one of nine patients.

Conclusions: Sarcoidosis should be considered in patients with fundus findings that resemble BCR or MFC. Initial evaluation should include chest x-ray and testing the angiotensin-converting enzyme level. These test results may be negative in patients outside the 20- to 40-year age group for typical sarcoid. Further evaluation with nondirected conjunctival biopsy and whole-body gallium scan may be indicated in certain patients, including (1) those with BCR or MFC with normal chest x-ray and elevated angiotensin-converting enzyme level; (2) patients older than 50 years with MFC; or (3) human lymphocyte antigen A29-negative BCR.

References (28)

  • H Weve

    Over keratitis profunda als uiting van de ziekte van Besnier-Boeck

    Ned Tijdschr Geneeskdl

    (1942)
  • FB Walsh

    Ocular importance of sarcoid. Its relation to uveoparotid fever

    Arch Ophthalmol

    (1939)
  • DJ Spalton et al.

    Fundus changes in histologically confirmed sarcoidosis

    Br J Ophthalmol

    (1981)
  • H Gould et al.

    Sarcoid of the fundus

    Arch Ophthalmol

    (1961)
  • Cited by (25)

    • Sarcoidosis

      2019, Journal Francais d'Ophtalmologie
    • Sarcoidosis

      2018, Journal Francais d'Ophtalmologie
      Citation Excerpt :

      As they disappear, they give way to secondary chorioretinal atrophy. According to certain authors, sarcoidosis should be ruled out in patients over 50 years of age with peripheral multifocal choroiditis, as well as those with lesions suggestive of birdshot chorioretinopathy who are HLA-A29 negative [50,51]. Optic nerve involvement is frequently observed.

    • Birdshot retinochoroidopathy: Key messages

      2016, Journal Francais d'Ophtalmologie
    • Birdshot chorioretinopathy

      2005, Survey of Ophthalmology
      Citation Excerpt :

      Nevertheless, pars planitis syndrome can almost always be distinguished from birdshot chorioretinopathy either by the presence of snowballs or snowbanking, or by the absence of birdshot lesions in later phases of the disease. Sarcoidosis is the disease that is most difficult to distinguish from birdshot chorioretinopathy, because its course is chronic, and fundus lesions can occur in patients with sarcoidosis that mimic birdshot lesions (Fig. 13).10,49,70,90 Patients with documented sarcoidosis who are HLA-A29–positive have been reported.90

    View all citing articles on Scopus

    Presented at the Retina Society, Williamsburg, Virginia, October 1994, and in part at the ARVO Annual Meeting, Sarasota, May 1994.

    Supported in part by the Vitreoretinal Research and Education Foundation, Philadelphia, Pennsylvania.

    View full text