BACKGROUNDSarcoidosis is a systemic granulomatous autoimmune disease of unknown etiology, which affects young adults. Up to 5% of patients with sarcoidosis may present neurological involvement, of both the central nervous system (encephalopathy, vasculopathy, granulomatous meningitis, myelopathy, or radiculopathy) and the peripheral nervous system.
CASE REPORTA 40-year-old man was admitted with a 4-month history of progressive loss of strength, and ascending sensitivity in the lower limbs, evolving later, with loss of bladder and rectal sphincter control, erectile dysfunction, imbalance, bilateral diplopia, dysphagia, hypophonia and cervical lymphadenopathy, with a magnetic resonance imaging (MRI) of the skull being performed that found medullary epiconus SD due to probable neurosarcoidosis. A chest computed tomography (CT) showed the presence of hilar and mediastinal pulmonary lymph nodes suggestive of sarcoidosis, in a lung biopsy there were areas of necrosis with noncaseating epithelioid granulomas, and a transbronchial biopsy revealed the same characteristics, with a scan for acid-fast bacilli (AFB) and negative fungi. Other etiologies such as neoplasia, tuberculosis, infection, inflammation and hypovitaminosis were evaluated and excluded. Therefore, pulse therapy with methylprednisolone 1 g/day was carried out for 5 days, and, thereafter, prednisone 60 mg/day was maintained. Notwithstanding, the patient presented therapeutic failure with a worsening of lung lesions and an increase in areas with hypoesthesia up to T10. Thus, methotrexate (MTX) at a dose of 20 mg/week was added to the use of the maintenance prednisone. Two months after starting MTX, due to an absence of clinical improvement, pulse therapy with cyclophosphamide 1 time per month was initiated, which continues to date, showing a gradual improvement in physical strength.
CONCLUSIONPatients with neurosarcoidosis require an early diagnosis and treatment, since the disease is systemic and possesses a variable pattern, which may be pointed, intermittent or progressive, in addition to presenting a 10% risk of death due to its existing inflammatory process or to its own treatment.
