Kajol Patel1, Matthias Dunse2, Walter Husar3
1Rutgers NJMS, 2Rutgers NJMS - Dept of Neurology, 3VA New Jersey Healthcare System
Background:
Sarcoidosis is an auto-inflammatory condition resulting in diffuse noncaseating granulomatous disease without a clear etiology. The chronic inflammatory state can lead to the involvement of the lungs, kidneys, skin, joint spaces, and more rarely, the nervous system. Neurosarcoidosis most often manifests as cranial mononeuropathies, most likely impacting cranial nerves VII and VIII.
Results:
This case report discusses a 50-year-old male with a past medical history of HIV, presenting with right leg numbness, right chest paresthesia and left sided motor deficits involving both the upper and lower extremities – consistent with Brown-Sequard syndrome. Cervical spinal MRI was significant for a 7.8 x 7 mm nodular enhancing, intramedullary lesion at the level of C5-C6 with edema extending up to C2 and down to T1. The patient was referred to neurosurgery due to the suspicion of a cord compressing tumor such as an ependymoma or astrocytoma. Computed tomography scan of the abdomen and pelvis displayed mediastinal lymphadenopathy. A subsequent bronchoscopy demonstrated cobblestone studding consistent with sarcoidosis and endobronchial biopsy confirmed the presence of non-caseating granulomas. Cerebrospinal fluid analysis was negative for infection. The patient was diagnosed with neurosarcoidosis and treated with high dose steroids which resulted in significant improvement of symptoms.
Conclusions:
His diagnosis also explains his history of right sided Bell’s palsy in 2017. His active HIV infection allowed his sarcoidosis to remain asymptomatic due to a lack of antibody response and depleted levels of CD4. Once the patient began treatment and his CD4/CD8 count rose, his sarcoidosis became symptomatic leading to his current presentation. This is the only reported case of sarcoidosis presenting as a Brown-Sequard pattern of spinal cord involvement. The purpose of this case report is to contribute to our understanding of different possible presentations of neurosarcoidosis.