Neurologic sarcoidosis

We discussed a case about a middle-aged woman with history of cluster migraines, presenting with chronic headaches & acute left eye optic neuritis and left CN V1-3 palsy, found to have neurologic sarcoidosis.

Sarcoidosis is a granulomatous disease that can affect all organ systems. It causes non-necrotizing (non-caseating) granulomas.

Epidemiology

  • African Americans 2-3x > Caucasians
  • Females 2x > males
  • Young adults

Pulmonary sarcoidosis
Chest radiographic findings are organized into stages. This gives an anatomic guide to lung involvement, but does not reflect disease activity or functional deficits.

  • Stage I:
    • Bilateral hilar adenopathy
  • Stage II:
    • Bilateral hilar adenopathy and parenchymal involvement (most commonly reticulonodular opacities)
  • Stage III:
    • Parenchymal involvement without adenopathy
  • Stage IV:
    • Fibrosis

Extrapulmonary sarcoidosis

  • Sarcoidosis can affect all organs
  • Most common extrapulmonary involvment
    • Skin
    • Eyes
    • RES
    • MSK
    • Exocrine glands
    • Heart
    • Kidney
    • CNS

Ocular Sarcoidosis

  • Affects up to 25% of pts with sarcoidosis
  • Females > males
  • More common in African American and Japanese populations
  • Intraocular: uveitis
  • Extraocular: lacrimal glands, conjunctiva, extraocular muscles, optic sheath

Lofgren syndrome
A specific acute presentation of sarcoidosis.
Classic triad of:

  • Bilateral hilar lymphadenopathy
  • Erythema nodosum
  • Arthropathy

Treatment

  • Initial: glucocorticoids
  • Refractory / intolerant to steroids: immunosuppression agents (MTX, azathioprine, leflunomide, or TNFα inhibitors

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