{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:11:34Z","timestamp":1788541894609,"version":"build-2803163510"},"reference-count":12,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,22]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Sarcoidosis is a diagnostically challenging and complex multisystem disease characterised by the formation of non-caseating granulomas. This case describes a young man who developed bitemporal vision loss that rapidly progressed to complete bilateral vision loss. MRI demonstrated chiasmatic and optic neuritis. A history of pulmonary nodules was noted. Via multi-disciplinary team discussion, no safe biopsy targets were identified. A clinical diagnosis of neurosarcoidosis was established. The patient\u2019s symptoms responded well to high-dose steroids and plasma exchange. Chiasmitis and optic neuritis are characteristic but rare manifestations of sarcoidosis. The progression of symptoms suggests migratory inflammation from the optic chiasm to the nerves. Diagnostic challenges are posed by the need to exclude mimics and the lack of sensitivity in serological markers. Literature provides an algorithm to support clinical diagnosis. There are no formal treatment guidelines. High-dose steroids and immunosuppression demonstrate effective treatment.<\/jats:p>","DOI":"10.1136\/bcr-2025-270070","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T14:05:26Z","timestamp":1769090726000},"page":"e270070","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Neurosarcoidosis: clinical diagnosis of migratory chiasmitis and bilateral optic neuropathy"],"prefix":"10.1136","volume":"19","author":[{"given":"Martin","family":"Regan","sequence":"first","affiliation":[{"name":"Kellgren Centre, Rheumatology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia Ying","family":"Tan","sequence":"additional","affiliation":[{"name":"North Manchester General Hospital, Manchester, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yee Ho","family":"Chiu","sequence":"additional","affiliation":[{"name":"Kellgren Centre, Rheumatology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"2026012206051592000_19.1.e270070.1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s41030-021-00161-w","article-title":"A Comprehensive Review of Sarcoidosis Diagnosis and Monitoring for the Pulmonologist","volume":"7","author":"Melani","year":"2021","journal-title":"Pulm Ther"},{"key":"2026012206051592000_19.1.e270070.2","doi-asserted-by":"crossref","DOI":"10.1212\/NXI.0000000000001084","article-title":"Neurosarcoidosis: Pathophysiology, Diagnosis, and Treatment","volume":"8","author":"Bradshaw","year":"2021","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"2026012206051592000_19.1.e270070.3","doi-asserted-by":"crossref","first-page":"e140","DOI":"10.1055\/s-0035-1549310","article-title":"A Rare Case of Isolated Cerebral Sarcoidosis Presenting as Suprasellar Mass Lesion with Salt-Wasting Hypopituitarism","volume":"76","author":"Krenzlin","year":"2015","journal-title":"J Neurol Surg Rep"},{"key":"2026012206051592000_19.1.e270070.4","doi-asserted-by":"crossref","DOI":"10.1212\/NXI.0000000000000270","article-title":"Optic neuropathy associated with systemic sarcoidosis","volume":"3","author":"Kidd","year":"2016","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"2026012206051592000_19.1.e270070.5","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2147\/EB.S29401","article-title":"Neuro-ophthalmic sarcoidosis","volume":"4","author":"Baughman","year":"2012","journal-title":"Eye Brain"},{"key":"2026012206051592000_19.1.e270070.6","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1007\/s11882-023-01092-z","article-title":"Neurosarcoidosis: Diagnostic Challenges and Mimics A Review","volume":"23","author":"Shen","year":"2023","journal-title":"Curr Allergy Asthma Rep"},{"key":"2026012206051592000_19.1.e270070.7","doi-asserted-by":"crossref","unstructured":"Chanpura A , Gupta RK , Sriwastava SK , et al . 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Case Rep Hematol 2016. doi:10.1155\/2016\/9495761","DOI":"10.1155\/2016\/9495761"},{"key":"2026012206051592000_19.1.e270070.11","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1007\/s00415-018-8928-2","article-title":"Sarcoidosis of the central nervous system: clinical features, imaging, and CSF results","volume":"265","author":"Kidd","year":"2018","journal-title":"J Neurol"},{"key":"2026012206051592000_19.1.e270070.12","doi-asserted-by":"crossref","first-page":"e591","DOI":"10.1097\/WNO.0000000000001108","article-title":"Neuro-Ophthalmic Manifestations of Sarcoidosis","volume":"41","author":"Henderson","year":"2021","journal-title":"J Neuroophthalmol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-270070","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T14:05:28Z","timestamp":1769090728000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-270070"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,22]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-270070"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-270070","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}