A rare comorbidity: neurosarcoidosis and cutaneous sarcoidosis

Abstract

We present a case of a neurosarcoidosis patient with skin lesions. A 50-year-old woman was admitted with a 1-year history of violaceous, smooth and shiny plaques on her face and right arm. These lesions were biopsied and the histological examination indicated sarcoidosis. The patient had a history of headache and syncope that lasted for about 1 h. Brain CT showed masses measuring 37×20 mm in both frontal lobes. Thoracic and abdominal CT showed many pathologically enlarged lymph nodes. The patient was diagnosed with cutaneous, lung and neuronal sarcoidosis, and treated with 20 mg/day methylprednisolone, 15 mg/week methotrexate, 10 mg/week folic acid, 400 mg/day hydroxychloroquine and 800 mg/day carbamazepine. One month later, the patient's neurological symptoms had improved and her skin lesions had decreased. At 6-month follow-up, the size of the cranial masses had markedly regressed.

Figure 1

Violaceous, smooth and shiny plaques on the nose and the left cheek.

Figure 2

Granulomatous structures made up of epithelioid histiocytes, with no central necrosis and no lymphocytes under the epithelium or in the shallow or deep dermis (×200 magnification, H&E stain).

Figure 3

Leptomeningeal and dural sarcoidosis of the brain in a 50-year-old woman. (A) T2-weighted axial image showing bilateral frontal dural masses to be low-signal intensity (arrows), with some high signal of adjacent brain parenchyma, most likely vasogenic oedema (arrowhead). (B) Contrast-enhanced T1-weighted axial image showing extra-axial-enhancing masses of bilateral frontal dura (arrows), and enhancement involving frontal cortical sulci (arrowhead). (C, D) T2-weighted and contrast-enhanced T1-weighted axial images obtained after therapy showing marked decrease in the size of bilateral frontal dural masses (arrows). Vasogenic oedema and enhancement involving frontal cortical sulci disappeared.

Figure 4

(A) Transverse CT image of the chest with mediastinal window setting showing bilateral hilar lymphadenopathy (arrows). (B,C) Transverse CT images of the chest showing micronodules along bronchovascular bundle (arrow), reticular density (arrow). (D) Transverse CT image obtained after therapy showing marked decrease in the size of reticular density (arrow).