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