Neurosarcoidosis presenting as longitudinally extensive myelitis: Diagnostic assessment, differential diagnosis, and therapeutic approach

Cicia, Alessandra; Nociti, Viviana; Bianco, Assunta; Fino, Chiara De; Carlomagno, Vincenzo; Mirabella, Massimiliano; Lucchini, Matteo

doi:10.1515/tnsci-2022-0231

Cited by 6 publications

(10 citation statements)

References 46 publications

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“…Our literature search revealed four other case reports of NS presenting with neurological deficits similar to GBS and transverse myelitis [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Neurosarcoidosis: A Unique Presentation of a Rare Disease

Girgis,

Retcho,

Pesenti

et al. 2023

Cureus

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Sarcoidosis is defined as an immune-mediated multi-organ granulomatous disease with unknown etiology, which is characterized by the presence of multiple non-caseating granulomas in the absence of a definite infective or toxic cause. Neurosarcoidosis (NS) occurs when sarcoid granulomas invade the central or peripheral nervous systems. Sarcoidosis usually presents with non-specific manifestations, including dry cough, fatigue, night sweats, weight loss, skin changes, and eye manifestations. Many patients who develop NS present with neurological manifestations within two years of being diagnosed with sarcoidosis. Herein, we present a case of newly diagnosed sarcoidosis in a 49-year-old male patient initially presenting with neurological manifestations of unknown origin, later identified as NS on peripheral lymph node biopsy with non-caseating granuloma.

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“…Our literature search revealed four other case reports of NS presenting with neurological deficits similar to GBS and transverse myelitis [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Neurosarcoidosis: A Unique Presentation of a Rare Disease

Girgis,

Retcho,

Pesenti

et al. 2023

Cureus

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“…All the patients reported improvements after the commencement of steroids and immunosuppressive management [ 8 ]. Cicia et al underlined a case of sarcoidosis-induced LETM in a 60-year-old male with no systemic manifestations, and his condition improved after starting immunosuppressive therapy [ 9 ]. Rodrigues et al also reported a case of LETM as an initial manifestation of sarcoidosis in a 53-year-old male.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging studies, such as MRI of the spine, are crucial in visualizing the characteristic longitudinally extensive lesion [ 13 ]. Additionally, a thorough evaluation of cerebrospinal fluid, including cell count, protein, and oligoclonal bands, aids in confirming the inflammatory nature of the myelitis [ 9 ]. Systemic investigations, such as chest imaging and ophthalmologic examination, are essential to identify the multiorgan involvement characteristic of sarcoidosis.…”

Section: Discussionmentioning

confidence: 99%

Neurosarcoidosis and Transverse Myelitis: Life-Threatening Manifestations of Sarcoidosis

Patel,

Shiwlani,

Kachhadia

et al. 2024

Cureus

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Sarcoidosis, a systemic granulomatous disorder, typically involves the lungs, skin, and lymph nodes. Neurological manifestations are diverse and may include longitudinally extensive transverse myelitis (LETM), an uncommon inflammatory disorder of the spinal cord. We present a case of a 62-year-old female with LETM as the initial manifestation of sarcoidosis. The patient exhibited progressive bilateral lower extremity weakness, urinary retention, and sensory disturbances. Diagnostic workup revealed characteristic findings on spinal magnetic resonance imaging (MRI), cerebrospinal fluid analysis, and thoracic biopsy. Treatment with high-dose corticosteroids and subsequent immunomodulatory therapy resulted in significant improvement. Our case highlights the importance of including sarcoidosis in the differentials of LETM, particularly in patients with no respiratory manifestations.

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“… 11 We have tabulated the reported cases of sarcoidosis‐induced LETM in the last 10 years (Table 1 ). 6 , 11 , 12 , 13 , 14 , 15 …”

Section: Discussionmentioning

confidence: 99%

Longitudinally extensive transverse myelitis as an initial manifestation of sarcoidosis: A rare case and its management

Kumar,

Bai,

Sanjna

et al. 2024

Clinical Case Reports

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Key Clinical MessageSarcoidosis‐induced LETM represents a rare but life‐threatening neurological manifestation of sarcoidosis, characterized by spinal cord inflammation, and associated neurological deficits. Sarcoidosis should be included in the differential diagnosis of LETM, particularly in patients with no lung involvement. Prompt recognition and management are obligatory to optimize outcomes and prevent long‐term disability.AbstractSarcoidosis is a multisystem inflammatory granulomatous disorder characterized by the formation of noncaseating granulomas. Although sarcoidosis commonly affects the skin, lymph nodes, and lungs, neurological involvement of sarcoidosis has also been reported. Longitudinally extensive transverse myelitis (LETM) is a rare but well‐documented serious manifestation of neuroscoidosis. We report a case of LETM caused by sarcoidosis in a 53‐year‐old male who presented with progressive bilateral lower extremity weakness, urinary retention, and paresthesia. Laboratory evaluations revealed elevated inflammatory markers. Magnetic resonance imaging of the spine showed hyperintense signals consistent with transverse myelitis. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis and elevated protein levels. Chest computed tomography showed hilar lymphadenopathy. A biopsy of the intrathoracic lymph node showed noncaseating granulomas consistent with sarcoidosis. A diagnosis of sarcoidosis‐induced LETM was made after ruling out all other possible etiologies. His condition improved gradually after starting high‐dose prednisone, mycophenolate, and rehabilitation strategies. Our case underscores the importance of prompt diagnosis and management of sarcoidosis‐induced LETM and highlights that sarcoidosis must be included among differential diagnoses of LETM, especially in cases with no lung involvement.

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Neurosarcoidosis presenting as longitudinally extensive myelitis: Diagnostic assessment, differential diagnosis, and therapeutic approach

Cited by 6 publications

References 46 publications

Neurosarcoidosis: A Unique Presentation of a Rare Disease

Neurosarcoidosis: A Unique Presentation of a Rare Disease

Neurosarcoidosis and Transverse Myelitis: Life-Threatening Manifestations of Sarcoidosis

Longitudinally extensive transverse myelitis as an initial manifestation of sarcoidosis: A rare case and its management

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