1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Shields R, Sagan O, Roebke L, Vander Maten J, Shah S, Chang G, Ibrahim D, Naz S. Rare case of multifocal extradural and intramedullary neurosarcoidosis without pulmonary involvement: a case report and literature review. Spinal Cord Ser Cases 2021; 7:89. [PMID: 34584071 PMCID: PMC8477626 DOI: 10.1038/s41394-021-00450-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction Sarcoidosis is a multisystem disease characterized histologically by noncaseating granulomas. Localization of sarcoidosis to the CNS is termed neurosarcoidosis, a complex and rare neuroinflammatory form of sarcoidosis. When the spinal cord is involved, lesions are often intradural. Here, we present a rare case of progressive myelopathy secondary to multifocal spinal extradural neurosarcoidosis with spinal cord compression and without pulmonary involvement. Case presentation A 29-year-old African American female presented to the emergency department with numbness and paresthesia of 2-month duration in her left lower extremity and 2-week duration in her right lower extremity. The patient reported difficulty ambulating, paresthesia below the umbilicus, and back pain radiating to bilateral lower extremities. She endorsed 9-month history of cough, subjective fevers, night sweats, and unintentional 15 kg weight loss. Examination revealed 4/5 strength in the left lower extremity. MRI of the brain and spinal cord revealed enhancing extradural lesions, with spinal cord compression at T8 measuring 1.3 × 1.9 cm. Lumbar puncture demonstrated oligoclonal bands and increased CSF neutrophils, lymphocytes, monocytes, and protein. T8 laminectomy with resection of the epidural lesion was performed. Histology showed granulomas, consistent with neurosarcoidosis. At follow-up, repeat spinal MRI revealed disease progression with intramedullary involvement. Long-term immunosuppressive treatment was eventually initiated with satisfactory response. Discussion This is a rare case of myelopathy secondary to spinal extradural neurosarcoidosis. Spinal neurosarcoidosis is predominantly an intradural process. Our review of the literature identified only seven cases of extradural neurosarcoidosis presenting with compressive myelopathy. Additional insight into management and rehabilitation following pathological diagnosis is of clinical significance.
Collapse
Affiliation(s)
- Ryan Shields
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA.
| | - Olivia Sagan
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Logan Roebke
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Josh Vander Maten
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Shailen Shah
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - George Chang
- Department of Pathology, The University of Toledo, Toledo, OH, USA
| | - Dalia Ibrahim
- Department of Pathology, The University of Toledo, Toledo, OH, USA
| | - Sumayya Naz
- Department of Neurology, The University of Toledo, Toledo, OH, USA
| |
Collapse
|
4
|
Recurrence of Epidural Spinal Sarcoidosis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202107000-00008. [PMID: 34270509 PMCID: PMC8288909 DOI: 10.5435/jaaosglobal-d-21-00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/20/2021] [Indexed: 11/21/2022]
Abstract
Neurosarcoidosis involving the spine is uncommon. Sarcoidosis of the spine usually presents as an intramedullary lesion and rarely an epidural lesion. To have recurrence of neurosarcoidosis is an even rarer presentation. Here, we present a 37-year-old man with poorly controlled sarcoidosis who initially presented to our medical center in 2015 with thoracic myelopathy from epidural spinal sarcoidosis treated with thoracic decompression and fusion. He presented to the hospital 5 years later with a month history of progressive upper extremity weakness. MRI revealed recurrent stenosis and spinal cord compression in the cervicothoracic junction. Urgent surgical intervention along with medical management resulted in symptomatic and functional improvement. Surgical intervention and compliance with postoperative corticosteroid therapy seem to yield a favorable prognosis for patients with epidural spinal sarcoidosis and to avoid recurrence.
Collapse
|
5
|
Khairy S, Alharbi NA, Alaglan A, Sufiani FA, Alkhani A. Cervical epidural neurosarcoidosis: A case report and literature review. Surg Neurol Int 2020; 11:133. [PMID: 32547820 PMCID: PMC7294160 DOI: 10.25259/sni_174_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/01/2020] [Indexed: 11/06/2022] Open
Abstract
Background: Neurosarcoidosis is a rare disease. In the spine, it commonly presents as an intramedullary lesion. Epidural spinal lesions are extremely rare. Case Description: A 29-year-old patient presented with a 22-month history of progressive neck, upper limb pain, and myelopathy. The cervical MRI showed a large epidural mass infiltrating the paraspinal soft tissue. After an open biopsy, the diagnosis of neurosarcoidosis was established and was followed-up by appropriate medical management. Conclusion: To manage cervical epidural neurosarcoidosis, first, you must obtain a tissue diagnosis and then follow with appropriate medical management.
Collapse
Affiliation(s)
- Sami Khairy
- Division of Neurosurgery, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - N A Alharbi
- Division of Neurosurgery, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abeer Alaglan
- Division of Neurosurgery, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fahd Al Sufiani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alkhani
- Division of Neurosurgery, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|