# A Case of Incomplete Heerfordt Syndrome Diagnosed Following Fever Onset

## TL;DR

A 78-year-old woman with fever, facial paralysis, and blurred vision was diagnosed with incomplete Heerfordt syndrome, a rare form of sarcoidosis.

## Contribution

This case highlights the importance of considering Heerfordt syndrome in patients with fever and neurological or ocular symptoms.

## Key findings

- The patient exhibited facial paralysis, blurred vision, and fever, consistent with incomplete Heerfordt syndrome.
- Lymph node biopsy confirmed sarcoidosis with non-caseating epithelioid cell granulomas.
- The diagnosis was made without requiring parotid swelling, emphasizing the incomplete form of the syndrome.

## Abstract

Heerfordt syndrome is a rare clinical manifestation of sarcoidosis characterized by a combination of facial nerve palsy, parotid gland swelling, anterior uveitis, and fever. The classical (complete) form presents with all four features, whereas the incomplete form requires the presence of at least two of the following: anterior uveitis, parotid enlargement, or facial nerve palsy. Parotid gland involvement is often bilateral, and uveitis may cause ocular symptoms such as blurred vision. A 78-year-old female presented with fever, a one-year history of facial paralysis, and blurred vision that was managed symptomatically on an outpatient basis. Computed tomography conducted two weeks prior to admission revealed hilar and mediastinal lymphadenopathy, while laboratory tests revealed elevated angiotensin converting enzyme (ACE) level and sIL-2 receptors. Lymph node biopsy confirmed a non-caseating epithelioid cell granuloma, leading to a diagnosis of sarcoidosis. A subsequent ophthalmological evaluation revealed uveitis, establishing a diagnosis of Heerfordt syndrome (incomplete owing to the absence of parotid swelling). Her fever and fatigue improved without steroid therapy, and she was followed up as an outpatient. Sarcoidosis is characterized by multiple systemic symptoms, including respiratory, cardiac, skin, neurological, and ocular involvement. This case suggests that Heerfordt syndrome should be considered as a differential diagnosis in patients with blurred vision, facial palsy, or parotid swelling accompanied by fever, to ensure prompt systemic assessment to differentiate and treat sarcoidosis.