Neurosarcoidosis: A Unique Presentation of a Rare Disease

Abstract

Sarcoidosis is defined as an immune-mediated multi-organ granulomatous disease with unknown etiology, which is characterized by the presence of multiple non-caseating granulomas in the absence of a definite infective or toxic cause. Neurosarcoidosis (NS) occurs when sarcoid granulomas invade the central or peripheral nervous systems. Sarcoidosis usually presents with non-specific manifestations, including dry cough, fatigue, night sweats, weight loss, skin changes, and eye manifestations. Many patients who develop NS present with neurological manifestations within two years of being diagnosed with sarcoidosis. Herein, we present a case of newly diagnosed sarcoidosis in a 49-year-old male patient initially presenting with neurological manifestations of unknown origin, later identified as NS on peripheral lymph node biopsy with non-caseating granuloma.

Keywords: neurological deficits; neurosarcoidosis; rare disease; rare presentation; sarcoidosis.

Figure 1. MRI of the lumbar spine showing nodular contiguous ventral and dorsal leptomeningeal enhancement (blue arrows)

Figure 2. MRI of the brain showing abnormal fluid-attenuated inversion recovery (FLAIR) signals in the periventricular regions (black arrows)

Figure 3. CT of the chest showing bilateral axillary lymphadenopathy (blue arrows)

Figure 4. CT of the chest showing two lung nodules in the right middle lobe (black arrows)

Figure 5. MRI of the brain with contrast showing abnormal enhancement of the posterior portions of the bilateral optic nerves (blue arrows) and optic chiasm (black arrows)