A Rare Case of Neurosarcoidosis Presenting as Severe Hypothermia

Abstract

BACKGROUND Sarcoidosis is a systemic disease of unclear etiology with an estimated prevalence of 10 cases per 100,000 population. Although sarcoidosis primarily affects the pulmonary system, it affects the nervous system in 5-10% of patients with the condition. CASE REPORT This article describes a case of neurosarcoidosis with the primary presenting finding of hypothermia. A 41-year-old African-American man with a past medical history significant for hypertension, asthma, and anemia, presented to the Emergency Department after being found unresponsive at home. The patient was found to have a significantly low temperature of 27.0°C on presentation. He was subsequently diagnosed with sarcoidosis by mediastinal biopsy, which revealed non-caseating granulomas with variable stages of sclerosis, consistent with long-standing sarcoidosis. In a subsequent admission, the patient presented with hyperthermia, further suggesting hypothalamic involvement as part of the neurosarcoidosis. CONCLUSIONS Neurosarcoidosis is a rare variant of sarcoidosis that has varying presentations, including headaches, seizures, ataxia, visual disturbances, loss of sensation, and other neurologic abnormalities. By presenting this case, which to our knowledge is the first to report neurosarcoidosis presenting as hypothermia, our aim is to use it as a teaching moment and for further discussion on clinical presentations and management of such patients.

Figure 1.

CT head showing cerebral edema and enlarged 4^th ventricle.

Figure 2.

MRI showing leptomeningeal enhancement, cortical swelling, and vasogenic edema.

Figures 3.

(A, B) Mediastinal biopsy revealing non-caseating granulomas and variable sclerosis, confirming long-standing sarcoidosis.