Spinal sarcoidosis presenting with epiconus syndrome

Area of Science:

• Neurology
• Immunology
• Radiology

Background:

• Neurosarcoidosis is a rare granulomatous disease affecting the nervous system.
• Spinal cord involvement in neurosarcoidosis is exceptionally uncommon.
• Early recognition and intervention are crucial for managing neurological deficits.

Observation:

• A patient presented with urinary dysfunction and progressive lower extremity numbness.
• Thoracic MRI revealed an extensive, gadolinium-enhancing spinal cord lesion.
• Chest CT showed hilar lymphadenopathy, with biopsy confirming sarcoidosis.

Findings:

• Initial methylprednisolone pulse therapy led to spinal lesion worsening.
• Adding methotrexate to the treatment regimen halted lesion progression and symptom exacerbation.
• Combined therapy demonstrated efficacy in managing spinal neurosarcoidosis.

Implications:

• This case underscores the importance of considering neurosarcoidosis in spinal cord lesions.
• Combined immunosuppressive therapy (methylprednisolone and methotrexate) may be a vital treatment strategy.
• Prompt diagnosis and multimodal treatment can potentially prevent irreversible neurological damage in spinal neurosarcoidosis.