A CASE REPORT OF NEURO SARCOIDOSIS P Sakhamuri MD, T Dao MD, M Matthew DO, A. Chauffe DO Department of Medicine, Louisiana State University Health Sciences Center, Lafayette, LA INTRODUCTION: Neuro sarcoidosis is an uncommon manifestation of sarcoidosis seen in only 3% of patients. Cranial neuropathy, meningitis, and peripheral neuropathy are the most common types of neurological diseases. CASE: 31-year-old male presented with chief complaints of double vision and binocular diplopia for one day. He also reported that his left eye was pulled inwards one day prior. He denied any headaches, dizziness, lightheadedness, balance issues, and had no other cranial nerve or motor/sensory deficits. The patient was seen in pulmonology clinic a few months prior for ongoing worsening shortness of breath with nonproductive cough for over 2 years. Computed Tomography of the thorax revealed bilateral hilar opacification with scattered nodules throughout the lungs. An extensive autoimmune and infectious work-up along with a bronchoscopy and subsequent biopsy revealed chronic granulomatous inflammation suggestive of pulmonary sarcoidosis. He was prescribed prednisone 40 mg; however, the prescription was never filled. In the background of pulmonary sarcoid his new symptoms of binocular diplopia with left lateral rectus palsy was concerning for neuro-sarcoid prompting an Magnetic Resonance Imaging of the brain revealing multifocal cerebral cortex nodules, scattered leptomeningeal enhancement, optic chiasm distal optic nerve enhancement along with chronic appearing non- enhancing T2 hyperintense foci of cerebellar white matter consistent with neuro sarcoid. Neurology and Rheumatology recommended that he receive Solumedrol 1000 mg for 5 days. He was discharged home on an oral prednisone taper with plans to eventually start on biologic disease-modifying anti-rheumatic drugs (DMARDs) as an outpatient. His symptom’s slowly but steadily improved. DISCUSSION: Sarcoidosis most commonly presents with lung disease or hilar lymphadenopathy, affecting 90–95 % of patients. The diagnosis of neuro sarcoidosis is always a challenge. For this reason, a definitive diagnosis requires the exclusion of other causes of neuropathy. Imaging findings in neuro sarcoid include dural thickening or leptomeningeal involvement, enhancing and non-enhancing parenchymal lesions, cranial nerve involvement (most commonly facial, optic however any nerve can be involved) and spinal or nerve root enhancement. Recognizing and correctly diagnosing neuro sarcoid leads to proper treatment and decreased morbidity in patients.
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