A Case of Incomplete Heerfordt Syndrome Diagnosed Following Fever Onset

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.