# Sarcoidosis: A Mimicker of Ocular Cicatricial Pemphigoid

## TL;DR

A 69-year-old woman with chronic eye symptoms was initially misdiagnosed with ocular cicatricial pemphigoid but later found to have ocular sarcoidosis after a biopsy.

## Contribution

This case highlights the diagnostic challenge of sarcoidosis mimicking ocular cicatricial pemphigoid and the importance of conjunctival biopsy.

## Key findings

- The patient's symptoms were initially attributed to ocular cicatricial pemphigoid but were later diagnosed as ocular sarcoidosis.
- A repeat conjunctival biopsy revealed granulomatous inflammation consistent with sarcoidosis.
- Treatment with prednisone and mycophenolate mofetil led to significant improvement in symptoms.

## Abstract

We report a rare case of ocular sarcoidosis presenting as bilateral cicatricial conjunctivitis, initially misdiagnosed as ocular cicatricial pemphigoid (OCP). A 69-year-old woman presented with a five-year history of chronic bilateral ocular irritation, trichiasis, conjunctival injection, and progressive cicatrization. She had previously undergone a conjunctival biopsy at an outside facility several years prior, which was reported without abnormal findings. Despite treatment with topical cyclosporine, artificial tears, and dapsone for presumed OCP, her symptoms persisted. A repeat conjunctival biopsy was eventually performed and revealed nodular epithelioid granulomatous inflammation with stromal fibrosis and scattered Langhans-type giant cells, consistent with ocular sarcoidosis. There was no prior history or systemic evidence of sarcoidosis. The patient was started on oral prednisone with a structured taper and mycophenolate mofetil. At the six-month follow-up, she reported marked improvement in ocular discomfort, with stabilization of cicatricial changes. This case highlights the importance of considering sarcoidosis in the differential diagnosis of chronic cicatrizing conjunctivitis, even in the absence of systemic findings, and underscores the diagnostic role of conjunctival biopsy in guiding management.