Neurological presentation of sarcoidosis

Address for correspondence: Elisangela Ferraz Pazinato (email: [e-mail]).

Abstract

Case Presentation: We herein present the case of a 49-year-old woman with complaints of vertigo, diplopia, nausea, headache, global paresis, inappetence, and intermittent febrile peaks in the afternoon. She had a history of hospitalization for evaluation and complementary propedeutics and underwent pulse therapy with corticosteroids for inflammatory disease of the unspecified central nervous system, with good response to corticosteroids. After four months, it evolved with worsening of gait, imbalance, mental confusion, bilateral facial paresis, speech disorders, progressive dysphagia for liquids and solids, consumption syndrome, and persistence of intermittent fever. The patient was hospitalized again and diagnosed with pan-hypopituitarism. Inguinal lymph node biopsy was performed, with findings of non-caseous epithelioid granulomas, configuring sarcoidosis with neurological presentation. Immunosuppressive treatment was instituted with adjustments according to therapeutic response, and treatment with rituximab and corticosteroids was maintained.

Discussion: Sarcoidosis consists of a systemic inflammatory disease that is characterized by the development of granulomas in any organ; however, neurosarcoidosis is a rare and difficult manifestation to diagnose. Although the most common manifestations in the central nervous system are cranial neuropathies, leptomeningeal disease, intraparenchymal lesions, and myelitis, the disease can manifest as stroke, seizure, hypopituitary, neuropsychiatric symptoms, and encephalopathy. We reported the case of a patient whose diagnostic investigation was challenging due to the multiple systemic and neurological manifestations.

Final Comments: The diagnosis of neurosarcoidosis is challenging because it is a chronic granulomatous disorder with no identified pathogen. The nerve injury most commonly involved is Bell paralysis. Isolated lumbar and thoracic root lesions have also been described, but sensorimotor neuropathy is rarely observed.

Publication History

Article published online:
02 October 2024