NEUROSARCOIDOSIS MASQUERADING AS A CENTRAL NERVOUS SYSTEM TUMOR.

Area of Science:

• Neurology
• Ophthalmology
• Pathology

Background:

• Sarcoidosis is a multisystem inflammatory disease characterized by noncaseating granulomas.
• Neurosarcoidosis, affecting the central nervous system (CNS), can present with diverse neurological deficits.
• Differentiating neurosarcoidosis from other CNS lesions, such as gliomas, is crucial for appropriate management.

Observation:

• A 38-year-old woman presented with unilateral blurry vision, progressing to bilateral optic nerve involvement.
• Initial brain MRI revealed a solitary lesion suggestive of a low-grade glioma, leading to a biopsy confirming gliosis.
• Subsequent clinical deterioration and neuroimaging changes prompted rebiopsy, revealing noncaseating granulomas consistent with neurosarcoidosis.

Findings:

• The initial presentation and imaging mimicked a central nervous system (CNS) glioma, highlighting the challenge in differentiating neurosarcoidosis.
• Sequential involvement of both optic nerves was a critical diagnostic clue.
• Histopathological examination evolved from gliosis to noncaseating granulomas, confirming neurosarcoidosis.

Implications:

• This case underscores the importance of considering neurosarcoidosis in the differential diagnosis of solitary CNS lesions, especially with atypical presentations.
• Serial ophthalmic examinations and neuroimaging are vital for accurate diagnosis and management of neurosarcoidosis.
• Early and accurate diagnosis of neurosarcoidosis can lead to timely treatment, preventing irreversible neurological damage.