Authors: Paula Olszewska , Maciej Olszewski , Oskar Bozek , Lukasz Mazurek , Tomasz Paleczny , Krzysztof Wierzbicki ,

Abstract

Background: Sarcoidosis, as a rare disease, affects 0.01% of the population; involvement of the central nervous system is even less common.

Case presentation: A 46-year-old man suffering from ulcerative colitis and epilepsy was hospitalized in the neurology department due to progressive, ascending paresthesia and quadriplegia accompanied by sphincter and balance disorders. Magnetic resonance imaging revealed extensive edematous changes extending from the medulla oblongata to the Th7 level and multiple enlarged mediastinal lymph nodes. Diagnostic workup was expanded to include a contrast-enhanced computed tomography scan of the chest, which revealed numerous enlarged lymph nodes in the mediastinum and scattered small nodular lesions in the lung parenchyma. After performing a histopathological examination of the subcarinal lymph node biopsy material, a diagnosis of sarcoidosis was made. The patient was diagnosed with longitudinal extensive transverse myelitis (LETM) in the course of probable neurosarcoidosis and was treated showed clinical improvement following treatment.

Conclusion: Although central nervous system involvement is not a common manifestation of this disease, immediate medical attention is necessary if it occurs. The management of patients with neurosarcoidosis requires a multidisciplinary approach, that improves the patient’s chances of achieving long-term remission.

Keywords: Case report, LETM, neurosarcoidosis, sarcoidosis, ulcerative colitis.