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Kumar A, Bai R, Sanjna F, Sonam F, Karishma F, Girish F, Ali MZ, Singh B, Ahmed Z, Mandal A. Longitudinally extensive transverse myelitis as an initial manifestation of sarcoidosis: A rare case and its management. Clin Case Rep 2024; 12:e9135. [PMID: 38979085 PMCID: PMC11228348 DOI: 10.1002/ccr3.9135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 07/10/2024] Open
Abstract
Key Clinical Message Sarcoidosis-induced LETM represents a rare but life-threatening neurological manifestation of sarcoidosis, characterized by spinal cord inflammation, and associated neurological deficits. Sarcoidosis should be included in the differential diagnosis of LETM, particularly in patients with no lung involvement. Prompt recognition and management are obligatory to optimize outcomes and prevent long-term disability. Abstract Sarcoidosis is a multisystem inflammatory granulomatous disorder characterized by the formation of noncaseating granulomas. Although sarcoidosis commonly affects the skin, lymph nodes, and lungs, neurological involvement of sarcoidosis has also been reported. Longitudinally extensive transverse myelitis (LETM) is a rare but well-documented serious manifestation of neuroscoidosis. We report a case of LETM caused by sarcoidosis in a 53-year-old male who presented with progressive bilateral lower extremity weakness, urinary retention, and paresthesia. Laboratory evaluations revealed elevated inflammatory markers. Magnetic resonance imaging of the spine showed hyperintense signals consistent with transverse myelitis. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis and elevated protein levels. Chest computed tomography showed hilar lymphadenopathy. A biopsy of the intrathoracic lymph node showed noncaseating granulomas consistent with sarcoidosis. A diagnosis of sarcoidosis-induced LETM was made after ruling out all other possible etiologies. His condition improved gradually after starting high-dose prednisone, mycophenolate, and rehabilitation strategies. Our case underscores the importance of prompt diagnosis and management of sarcoidosis-induced LETM and highlights that sarcoidosis must be included among differential diagnoses of LETM, especially in cases with no lung involvement.
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Affiliation(s)
- Aman Kumar
- Shaheed Mohtarma Benazir Bhutto Medical UniversityLarkanaPakistan
| | - Rakhi Bai
- Shaheed Mohtarma Benazir Bhutto Medical UniversityLarkanaPakistan
| | - Fnu Sanjna
- Shaheed Mohtarma Benazir Bhutto Medical CollegeLayariPakistan
| | - Fnu Sonam
- Chandka Medical CollegeLarkanaPakistan
| | - Fnu Karishma
- Ghulam Muhammad Mahar Medical CollegeSukkurPakistan
| | - Fnu Girish
- Ghulam Muhammad Mahar Medical CollegeSukkurPakistan
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Chaubey M, Meena K, Singh T, Reddy S, Raj R, Chaudhary A, Mishra V, Chakravarty J. Neurosarcoidosis: An under-diagnosed cause of myelopathy. J Family Med Prim Care 2024; 13:2157-2160. [PMID: 38948561 PMCID: PMC11213433 DOI: 10.4103/jfmpc.jfmpc_987_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 07/02/2024] Open
Abstract
Sarcoidosis is a granulomatous disorder with multi-organ involvement, and etiology still remains unknown. Neurosarcoidosis is the involvement of the nervous system in sarcoidosis. Spinal cord involvement is usually intra-dural, but extra-dural involvement can also occur. Here, we report a case of 30 years old lady presenting with subacute onset paraparesis with bladder and bowel involvement, which was finally diagnosed as sarcoidosis-associated myelopathy with the longitudinally extensive transverse myelitis (LETM) phenotype.
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Affiliation(s)
- Manaswi Chaubey
- Department of General Medicine, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Kapil Meena
- Department of General Medicine, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Tamanna Singh
- Department of General Medicine, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Sudheer Reddy
- Department of General Medicine, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Rajhans Raj
- Department of General Medicine, IMS, BHU, Varanasi, Uttar Pradesh, India
| | | | - Vaibhav Mishra
- Department of General Medicine, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Jaya Chakravarty
- Department of General Medicine, IMS, BHU, Varanasi, Uttar Pradesh, India
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Patel M, Shiwlani S, Kachhadia MP, Abdalla M, Samreen I, Mohamed AS, Nasir H. Neurosarcoidosis and Transverse Myelitis: Life-Threatening Manifestations of Sarcoidosis. Cureus 2024; 16:e52629. [PMID: 38374863 PMCID: PMC10876160 DOI: 10.7759/cureus.52629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Sarcoidosis, a systemic granulomatous disorder, typically involves the lungs, skin, and lymph nodes. Neurological manifestations are diverse and may include longitudinally extensive transverse myelitis (LETM), an uncommon inflammatory disorder of the spinal cord. We present a case of a 62-year-old female with LETM as the initial manifestation of sarcoidosis. The patient exhibited progressive bilateral lower extremity weakness, urinary retention, and sensory disturbances. Diagnostic workup revealed characteristic findings on spinal magnetic resonance imaging (MRI), cerebrospinal fluid analysis, and thoracic biopsy. Treatment with high-dose corticosteroids and subsequent immunomodulatory therapy resulted in significant improvement. Our case highlights the importance of including sarcoidosis in the differentials of LETM, particularly in patients with no respiratory manifestations.
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Affiliation(s)
- Mitwa Patel
- Internal Medicine, David Tvildiani Medical University, Tbilisi, GEO
| | | | | | | | - Iqra Samreen
- Internal Medicine, Augusta University, Augusta, USA
| | | | - Hira Nasir
- Internal Medicine, Mayo Hospital, Lahore, PAK
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Cassimatis N, Hong E, Trippiedi A, Lauer SA. Neurosarcoidosis Presenting as Longitudinally Extensive Transverse Myelitis and Orbital Mass: A Case Report. Cureus 2023; 15:e37821. [PMID: 37213995 PMCID: PMC10197910 DOI: 10.7759/cureus.37821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
We describe a case of neurosarcoidosis in a 64-year-old female who presented with proptosis and orbital inflammation together with bilateral lower extremity neuropathy and longitudinally extensive transverse myelitis. These two entities are not commonly associated, and the etiology of the transverse myelitis was facilitated by an orbital biopsy. The transverse myelitis caused numbness in her lower extremities and tightness in her chest and abdomen, which progressed over weeks to difficulty walking and bilateral neuromuscular weakness. Magnetic resonance imaging (MRI) revealed longitudinally extensive transverse myelitis in the cervical and thoracic spine. Computed tomography (CT) imaging of the chest revealed right hilar and mediastinal lymphadenopathy and calcified subcarinal nodes. Positron emission tomography (PET) scan revealed hypermetabolism in the mediastinum and medial left orbit. Orbital biopsy revealed non-necrotizing granulomatous inflammation suggestive of sarcoidosis. The neurologic deficits and orbital inflammation responded well to intravenous corticosteroids. Neurosarcoidosis can present with unusual clinical manifestations, as evidenced by this patient.
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Affiliation(s)
- Nicholas Cassimatis
- Neurological Surgery, Hackensack Meridian School of Medicine, Hackensack, USA
| | - Ellen Hong
- Internal Medicine, Hackensack Meridian School of Medicine, Hackensack, USA
| | - Andrew Trippiedi
- Ophthalmology, Hackensack Meridian School of Medicine, Hackensack, USA
| | - Simeon A Lauer
- Ophthalmology, Hackensack University Medical Center, Hackensack, USA
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Li X, Morantes Gomez L, Al Masry M, Basuroski ID. "String of pearls" in spinal cord sarcoidosis. Ann Neurol 2022; 92:686-687. [PMID: 35929108 DOI: 10.1002/ana.26471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Xiaoyang Li
- University of North Carolina School of Medicine, Department of Neurology, Chapel Hill, North Carolina, USA
| | | | - Mahmoud Al Masry
- University of North Carolina REX Hospital, Raleigh, North Carolina, USA
| | - Irena Dujmovic Basuroski
- University of North Carolina School of Medicine, Department of Neurology, Chapel Hill, North Carolina, USA.,The Bodford Family Transverse Myelitis Center, Hillsborough, NC, USA
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Rare Case of Spinal Neurosarcoidosis with Concomitant Epidural Lipomatosis. Case Rep Neurol Med 2021; 2021:5952724. [PMID: 33604089 PMCID: PMC7869444 DOI: 10.1155/2021/5952724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 12/13/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Spinal neurosarcoidosis is a rare disease that can manifest as myelopathy, radiculopathy, or cauda equine syndrome. Spinal epidural lipomatosis is also a rare condition resulting from overgrowth of epidural fat tissue causing compressive myelopathy. To our knowledge, there are no reports linking epidural lipomatosis and spinal neurosarcoidosis. Case Report. We describe a case of progressive myelitis in the presence of concomitant spinal neurosarcoidosis and epidural lipomatosis which was a challenging diagnosis with complete response to treatment after addressing both diseases. Both etiologies are inflammatory in nature and share similar expression of inflammatory factors such as TNF-α and IL-1β. Conclusion The common inflammatory process involved in these two diseases might explain a pathophysiological interconnection between both diseases that may underlie their concomitant development in our patient. If these two diseases are interconnected, in their pathophysiological mechanism remains a hypothesis that will need further investigation.
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Longo M, Gelfand Y, Kinon MD, Pullman J, Yassari R. Multifocal Epidural Neurosarcoidosis Causing Spinal Cord Compression: A Case Report. Cureus 2019; 11:e4177. [PMID: 31093476 PMCID: PMC6502289 DOI: 10.7759/cureus.4177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We describe a rare case of multifocal extramedullary epidural neurosarcoidosis that presented with myelopathy without motor deficits and perform a literature review for previous cases of epidural neurosarcoidosis. A 46-year-old woman presented with lower back pain, urinary incontinence, gait disturbance, and sensory loss without motor deficits. Spine magnetic resonance imaging (MRI) showed multiple epidural lesions, the largest causing spinal cord compression at the T5 level. A computed tomography (CT)-guided biopsy of the dominant lesion showed noncaseating granulomas consistent with neurosarcoidosis. She was treated with a course of dexamethasone and discharged home after a 10-day hospital course. She was discharged home on oral prednisone taper over a four-month period. At her latest follow-up, she is neurologically intact and gainfully employed. This case demonstrates that certain cases of epidural neurosarcoidosis causing spinal cord compression may be treated with medical therapy alone in the absence of severe neurological deficits.
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Affiliation(s)
- Michael Longo
- Neurosurgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
| | - Yaroslav Gelfand
- Neurosurgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
| | - Merritt D Kinon
- Neurosurgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
| | - James Pullman
- Neurosurgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
| | - Reza Yassari
- Neurosurgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
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Li X, Lu Z, Wang Y. Syringomyelia-like syndrome in neuromyelitis optica spectrum disorder complicated with Sjogren's syndrome: a case report. BMC Neurol 2018; 18:168. [PMID: 30301458 PMCID: PMC6178268 DOI: 10.1186/s12883-018-1170-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Besides CSF-flow obstruction, syringomyelia is associated with inflammatory spinal cord lesions. However, syringomyelia-like syndrome concomitant with neuromyelitis optica spectrum disorder (NMOSD) and primary Sjogren’s syndrome (pSS) is extremely rare. Here, we would like to report a case of a patient with syringomyelia-like syndrome in NMOSD complicated with Sjogren’s Syndrome. Case presentation A 64-old male Han Chinese, presented with three episodes of acute demyelinating processes in the central nervous system within 5 years. Firstly, he presented with ascending left lower extremity weakness and numbness, and initially progressive loss of vision in the right eye before 5 years, and subsequently in the right eye 2 months later. High dose corticosteroid therapy was prescribed for this attack. Second, he suffered from refractory gastrointestinal symptoms. such as nausea, vomiting, abdominal pain and early satiety. After the second episode, he received long-term azathioprine and prednisone treatment in low dosages. Six months before admission, he developed the lower back pain and numbness in lower limbs, and urinary incontinence. This time, he complained of acute onset of right lower limb paralysis, paresthesia and urinary incontinence. MRI of the spine revealed a syringomyelia extending from the C7 to T4 levels with serum positive anti-aquaporin-4 antibodies (AQP4-Ab) (indirect immunofluorescence on AQP4 transfected cells). he was serologically positive for both anti-Sjögren’s syndrome-related antigen A and B antibodies and there was reduced salivary flow on scintigraphy. Lip salivary gland (LSG) biopsies were graded (grade four lymphocytic infiltration) according to the Chisholm and Mason classification system and by morphometric analysis. And finally, diagnosed as syringomyelia-like syndrome in NMOSD complicated with Sjogren’s syndrome. Conclusions Although extremely rare, This index patient highlights that syringomyelia could be associated with underlying NMOSD and pSS, and autoimmune disorders should be considered in the initial differential diagnosis, This is very helpful for the therapeutic implications and evaluating curative effect.
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Affiliation(s)
- Xiangling Li
- Department of Nephrology, Department of Internal Medicine, Wei fang Medical University, Weifang, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanqiang Wang
- Department of Neurology, The Affiliated Hospital of Wei fang Medical University, No 2428 Yuhe Road, Weifang, 261031, Shandong, China.
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