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Case Reports
. 2023 Aug 10;15(8):e43254.
doi: 10.7759/cureus.43254. eCollection 2023 Aug.

Neurosarcoidosis With Multi-Organ Involvement: A Case Report and Literature Review

Nicolas Naccarella  1 , Samia Ikhlef  2 , Jacques Rommens  3
Affiliations
Case Reports

Neurosarcoidosis With Multi-Organ Involvement: A Case Report and Literature Review

Nicolas Naccarella et al. Cureus. .

Abstract

Sarcoidosis is a multisystemic disease that, in rare cases, can involve the central nervous system (CNS). We present a case of sarcoidosis with intracranial and multi-organ involvement. The patient presented with a one-month history of headaches. Imaging revealed leptomeningeal nodular enhancement (LNE), and a PET/CT scan of the chest and abdomen showed bilateral hilar, retroperitoneal, and inguinal lymphadenopathy. The diagnosis of sarcoidosis was confirmed by an ultrasound-guided inguinal lymph node biopsy. The patient was started on a combination of corticosteroids and immunosuppressive drugs, with a gradual improvement in symptoms and radiological findings over several months.

Keywords: central nervous system disease; headaches; neuro mri; neurosarcoidosis; nodular leptomeningeal enhancement; walking disorder.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Brain CT scan with nodular leptomeningeal enhancement and lymphadenopathies in the upper part of the mediastinum
Initial venous CT showing multiple hyperdensities in cerebral hemispheres predominantly in the temporal lobes corresponding to nodular leptomeningeal enhancement (black arrows) displayed with axial (A,B) and coronal (C) planes. It refers to the presence of nodules or areas of increased contrast enhancement in the leptomeninges. The arterial phase included the upper part of the mediastinum that demonstrated hilar lymphadenopathies (black stars) (D). CT: computed tomography
Figure 2
Figure 2. Brain MRI
MRI showing the leptomeningeal nodular enhancement (black arrows) displayed on post-contrast axial T1WI (A,B). Recent pontic and brain stem ischemic lesions are demonstrated (black arrows), characterized by a hypersignal on sequences axial T2 (C) and axial FLAIR (D) with diffusion restriction (E,F). MRI: magnetic resonance imaging, T1WI: T1-weighted image, FLAIR: fluid-attenuated inversion recovery
Figure 3
Figure 3. Multiple mediastinal, hilar, retroperitoneal, and inguinal hypermetabolic lymphadenopathies
Axial FDG-PET/CT (A) shows in white mediastinal, hilar, and axillary lymphadenopathies with an elevated SUV. Axial chest CT (B) shows nodular and micronodular involvement of the subpleural and peribronchovascular regions in the upper segment of the left lower lobe (black arrow). The SUVmax was 8.88. FDG-PET/CT: fluorodeoxyglucose-positron emission tomography/computed tomography, SUV: standardized uptake value, CT: computed tomography, SUVmax: maximum standardized uptake value
Figure 4
Figure 4. Axial FDG-PET/CT and scrotal ultrasonography
Axial FDG-PET/CT (A) shows in white left testicular lesion with elevated SUV. Ultrasonography shows two nodular hypoechoic lesions (black arrows) in both testes appearing hypermetabolic on PET/CT, seen on the left (B) and the right (C). The SUVmax was 8.88. FDG-PET/CT: fluorodeoxyglucose-positron emission tomography/computed tomography, SUV: standardized uptake value, SUVmax: maximum standardized uptake value
Figure 5
Figure 5. Brain MRI after three months of treatment
MRI showing complete resolution of the leptomeningeal nodular enhancement after treatment (black stars) displayed on post-contrast axial T1WI (A,B). Pontic and brain stem chronic ischemic lesions are demonstrated (black arrows), characterized by a hypersignal on sequences axial T2 (C) without diffusion restriction (D,E). MRI: magnetic resonance imaging, T1WI: T1-weighted image
Figure 6
Figure 6. FDG-PET/CT after three months of treatment
Axial FDG-PET/CT showed complete remission of mediastinal, hilar, and hypermetabolic lymphadenopathies (black star). FDG-PET/CT: fluorodeoxyglucose-positron emission tomography/computed tomography
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