Recurrent Bifacial Neuropathy in a Case of Steroid Responsive Neurosarcoidosis: A Case Report

George P. Garcia Lawrence, Raymond L. Rosales

Sep 2017 DOI 10.35460/2546-1621.2017-0055     Access   

Abstract

Neurosarcoidosis is a rare or misdiagnosed disease that can be masked in a case with fl eeting neurologic defi cits, especially craniopathy. We present a 26-year-old Chinese-Filipino male who presented with recurrent facial neuropathy that was heralded by fl eeting blurring of vision bilaterally. He was apparently responsive to corticosteroids (intravenous and oral methylprednisolone) from initiation to date. During the course, he also noted selective weakness of the right fi nger fl exors. Nodules in the face eventually appeared that led to a biopsy disclosing a noncaseating granuloma. Apart from electrodiagnostic tests, a supportive diagnostic test for sarcoidosis was the presence of lymphadenopathies on his chest noted on Computed Tomography (CT) scan. Cerebrospinal fl uid (CSF) and brain Magnetic Resonance Imaging (MRI) tests were not yielding. To our knowledge, this was the fi rst reported Chinese-Filipino case of neurosarcoidosis involving cranial and peripheral nerves.

Keywords: case report, sarcoidosis, neurosarcoidosis, cranial nerve, neuropathy, noncaseating, granulomatous, steroid responsive.

  1. Dutra, LA., Braga-Neto P., Oliveira RA., et al. Neurosarcoidosis: guidance for the general neurologist. Arq Neuropsiquiatr 2012;70(4):293-299
  2. Imran, TF., Nizami, S., Eyzner, I., et al. Vertigo as a Predominant Manifestation of Neurosarcoidosis. Case Reports in Medicine Volume 2015
  3. Mercan, M., Akyol, A., Karaman, Y., Bolay, H. A Case of Sarcoidosis of the Central Nervous System and Orbita. Case Reports in Medicine Volume 2015
  4. Ropper, AH.,Samuels, MA., Klein, JP. Infections of the Nervous System (Bacterial, Fungal, Spirochetal, Parasitic) and Sarcoidosis. Chapter 32, Adams and Victor’s Principles of Neurology, 10th edition, 2014: p. 721-723
  5. Ghozzi, A., Azouz, H., Chelly, I., et al. Unusual presentation of sarcoidosis: solitary intracranial mass lesion mimicking an intracranial neoplasm: a case report. Pan African Medical Journal. 2014; 18:236
  6. Lacomis, David. Neurosarcoidosis. Current Neuropharmacology, 2011, 9, 429-436
  7. Hoyle, JC., Jablonski, C., Newton, HB. Neurosarcoidosis: Clinical Review of a Disorder With Challenging Inpatient Presentations and Diagnostic Considerations. The Neurohospitalist 2014, Vol. 4(2) 94-101
  8. Leonhard, SE., Fritz, D., van de Beek, D., et al. Cryptococcal meningitis complicating sarcoidosis. Medicine (2016) 95:35
  9. Sapkota, S., Sapkota, B., Pitiyanuvath,N. Hashimoto Encephalopathy or Neurosarcoidosis? A Case Report. The Neurohospitalist 2015, Vol. 5(2) 70-73
  10. Hoistma E., Drent M., Sharma OP. A pragmatic approach to diagnosing and treating neurosarcoidosis in the 21st century. Current Opinion in Pulmonary Medicine 2010, 16:472–479
  11. Sano, H., Deguchi, I., Fukuoka, T., et al. Intractable Neurosarcoidosis Effectively Treated with Infliximab. Intern Med 2016 (55): 811-814.
  12. Komurcu, HF, Anlar, O. Melkersson-rosenthal syndrome associated with hemifacial spasm. International Journal of Research in Medical Sciences. 2015 Dec; 3(12): 3879-3881
  13. Bhat, R., Ahad, R., Ahmed, I., Lee, G., Khosla, S. Neurosarcoidosis Presenting as Acute Inflammatory Polyneuropathy. Neurology April 5, 2016 vol. 86 no. 16 Supplement P6.142
  14. Hewlett, RH., Brownell, B. Granulomatous myopathy: its relationship to sarcoidosis and polymyositis. Journal of Neurology, Neurosurgery, and Psychiatry, 1975, 38, 1090-1099.

Articles related to the one you are viewing

There are currently no results to show, please try again later

CC BY: Open Access Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/