J Neurocrit Care.  2020 Jun;13(1):57-60. 10.18700/jnc.190112.

Cervical myelitis in a patient with pulmonary sarcoidosis

• Chung EJ
• Lee SY
• Lee JH
• Park YA
• Chun BK
• Huh SY

• KMID: 2503386
• DOI: http://doi.org/10.18700/jnc.190112

Abstract

Background
Sarcoidosis is a multisystemic disease characterized by noncaseating granulomas, predominantly affecting organs such as the lungs and lymph nodes. Spinal cord involvement of sarcoidosis is uncommon.
Case Report
A 32-year-old male presented with bilateral pain and numbness in his upper extremities for 1 year. He had pulmonary sarcoidosis 4 years ago. Spinal magnetic resonance imaging showed a cord lesion with enhancement at the C5 to C6 level. Chest computed tomography revealed the increased size of the lymph nodes compared to previously. His serum angiotensin-converting enzyme level was elevated. He was diagnosed with myelitis caused by sarcoidosis. After steroid treatment, the numbness improved, but the pain still persisted.
Conclusion
To enable the early detection and treatment of neurosarcoidosis among patients with systemic sarcoidosis, a high degree of suspicion is required. Neurological complications can be minimized if it is detected and treated early.

Keyword

Neurosarcoidosis; Myelitis; Spinal cord

Figure

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  Fig. 1. (A) Four years ago, contrast-enhanced chest computed tomography (CT) showing enlargement of multiple lymph nodes. (B) Histopathology showing noncaseating granulomatous inflammation (hematoxylin and eosin stain, ×100). (C) At the time of diagnosing cervical myelitis. Chest CT shows the slightly increased size of the paratracheal and hilar lymph nodes (arrows).

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  Fig. 2. (A) Sagittal T2-weighted magnetic resonance imaging (MRI) of the cervical spine showing a short segment of high signal intensity at the C5–C6 level. (B) T1-weighted gadolinium-enhanced image showing subtle enhancement between C5 and C6 segments (arrow). (C) Axial T2-weighted MRI showing bilaterally asymmetric linear foci of high T2-weighted signals. (D) Subtle enhancement can be seen on the left side of the spinal cord.

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  Fig. 3. Follow-up cervical spinal magnetic resonance imaging 2 months after intravenous methylprednisolone treatment. (A, C) T2-weighted images with a persistent high signal intensity. (B, D) T1-weighted gadolinium images showing diminished enhancement.

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