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Sarcoidosis Presenting as Cranial Multinevritis.
Sara Xavier Pires1, Guiomar Pinheiro1, Luisa Serpa Pinto1
1Internal Medicine Department, Centro Hospitalar e Universitario do Porto, Porto, Portugal.
Sarcoidosis is a rare condition that can affect the central nervous system, presenting with diverse symptoms like facial palsy and uveitis. Early diagnosis and treatment are crucial to prevent permanent damage.
Area of Science:
- Neurology
- Pulmonology
- Ophthalmology
Background:
- Sarcoidosis is an inflammatory disease characterized by granuloma formation in various organs.
- Central nervous system (CNS) involvement in sarcoidosis is uncommon, occurring in 5-10% of cases.
- CNS sarcoidosis can be the initial presentation, often with heterogeneous and easily overlooked symptoms.
Observation:
- A 29-year-old woman presented with red eyes, hearing loss, and acute facial palsy.
- Ophthalmologic exam showed bilateral uveitis; lumbar puncture indicated aseptic meningitis.
- Imaging revealed pulmonary nodules and mediastinal/hilar lymphadenopathy.
Findings:
- Bronchoalveolar lavage demonstrated a CD4/CD8 ratio of 8.
- Lymph node biopsy confirmed non-caseating granulomas, leading to a sarcoidosis diagnosis.
- The patient exhibited ocular, pulmonary, and neurological involvement.
Implications:
- Prompt diagnosis of neurosarcoidosis is essential due to its potential for severe, irreversible damage.
- Systemic corticosteroids and methotrexate were initiated, leading to clinical improvement.
- Increased clinician awareness is vital for early detection and management of this rare condition.
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