Abstract
Neurosarcoidosis is a rare identity and occurs in only 5% to 15% of patients with sarcoidosis. It can manifest in many different ways, and therefore, diagnosis may be complicated. We report a case presented in a very unusual manner with involvement of 3 cranial nerves; anosmia (NI), facial palsy (NVII), and hearing loss (NVIII). When cranial nerve dysfunction occurs, it is very important to take neurosarcoidosis into consideration.
1
Introduction
Sarcoidosis is a multisystem disorder of unknown etiology. Despite its predilection for the lungs, sarcoidosis can target every organ. However, neurosarcoidosis is rare and occurs in only 5% to 15% of patients .
Neurosarcoidosis can manifest in many different ways, and any part of the nervous system can be affected . Therefore, the diagnosis may be complicated. In neurosarcoidosis, the cranial nerves are commonly involved, being affected in as many as 75% of those patients. In most patients, more than 1 cranial nerve is involved .
Because of its infrequency, there is a paucity in published articles . Here, a case of cranial nerve dysfunction caused by sarcoidosis is described, presenting very unusual involvement of 3 cranial nerves; anosmia (NI), facial palsy (NVII), and hearing loss (NVIII).
2
Case report
A healthy 26-year-old woman developed a left-sided facial palsy a few days after a flu-like illness. She was treated with valacyclovir 1000 mg 3 times a day and prednisolone 25 mg 2 times a day for a week. However, a month hereafter, there was no improvement, and the patient was referred to our hospital. At that time, she also had hearing loss of the left ear, headache, and malaise.
Physical examination showed a facial nerve palsy on the left side, grade III (House-Brackmann grading system ), and a painful left parotic gland. Audiometry revealed a sensorineural hearing loss of approximately 40 to 50 dB on both sides ( Fig 1 A and B). Other cranial nerves functioned normally, and further neurologic examination was without abnormalities. Lues, human immunodeficiency syndrome, and Borrelia were tested, but serology proved negative. Angiotensin-converting enzyme level was slightly increased (89 IU/L; reference range, 7.0–21.4 IU/L), and the sedimentation rate of the erythrocytes was 25 mm/h. In addition, the chest x-ray showed evident hilar lymphadenopathy ( Fig 2 ). The result of cerebrospinal fluid examination was normal. Postcontrast magnetic resonance imaging (MRI) examinations of the brain demonstrated marked enhancement of the seventh left cranial nerve and both eighth cranial nerves ( Fig 3 A and B). The diagnosis of neurosarcoidosis was made. The patient was treated with methylprednisolone 1000 mg daily during the first 3 days. Hereafter, prednisolone 40 mg was given daily, and this was tapered during the next several months. There appeared to be no involvement of the eye and the heart. However, the patient complained of a rapidly progressive joint pain while on corticosteroid treatment. The diagnosis oligoarthritis caused by sarcoidosis was made.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
