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An Atypical and Multifactorial Acute Immune Polyradiculopathy: A Case Report.

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Diagnosing patients with multiple coexisting diseases presents a challenge. This case highlights sarcoidosis and neurofascin antibodies in a patient with neuropathies, successfully treated with steroids.

Keywords:
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Area of Science:

  • Neurology
  • Immunology
  • Pathology

Background:

  • Clinical diagnosis typically seeks a single cause for symptoms.
  • Coexistence of multiple pathological entities poses diagnostic challenges.
  • Diagnostic evaluation should continue beyond the first positive finding.

Observation:

  • A 47-year-old woman presented with multiple cranial neuropathies and polyradiculopathy.
  • Cerebrospinal fluid analysis revealed significant pleocytosis.
  • The evaluation identified concurrent sarcoidosis and antibodies against neurofascin (NF)-155 and NF-140.

Findings:

  • Pathological evidence of sarcoidosis was confirmed.
  • Molecular evidence indicated the presence of anti-neurofascin antibodies (NF)-155 and NF-140.
  • The precise pathogenic contribution or interaction between these entities remains unclear.

Implications:

  • This case underscores the complexity of diagnosing patients with overlapping conditions.
  • It illustrates the clinical application of balancing diagnostic principles like Occam's razor and Hickam's dictum.
  • Effective management was achieved with corticosteroid therapy, suggesting an inflammatory or immune-mediated component.