TACHES DE BOUGIE

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). Meth ods: 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 recor ds of these patients were reviewed. Results: Two patterns of taches de bougie were observed, Sixteen patients (73%) had small, discrete whit e 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. V isual 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 patien ts with posterior streaks. Serum angiotensin-converting enzyme was neg ative in 5 of 14 patients. Gallium scan showed increased hilar uptake in five patients, three of whom had a normal chest x-ray. Human lympho cyte antigen A29 was positive in one of nine patients. Conclusions: Sa rcoidosis should be considered in patients with fundus findings that r esemble BCR or MFC. Initial evaluation should include chest x-ray and testing the angiotensin-converting enzyme level. These test results ma y be negative in patients outside the 20- to 40-year age group for typ ical sarcoid. Further evaluation with nondirected conjunctival biopsy and whole-body gallium scan may be indicated in certain patients, incl uding (1) those with BCR or MFC with normal chest x-ray and elevated a ngiotensin-converting enzyme level; (2) patients older than 50 years w ith MFC; or (3) human lymphocyte antigen A29-negative BCR.