We report a case of central nervous system (CNS) sarcoidosis in a young girl and review the literature on the CNS manifestations of sarcoidosis in 23 cases occurring in children.NUMEROUS extensive reviews of sarcoidosis in the pediatric age group have been published.'-' The neurologic manifestations of sarcoidosis have also been extensively reviewed.9-16 However, the unusual occurrence of central nervous system (CNS) sarcoidosis in children has not been reviewed previously. We present a case report as an introduction to a literature survey. Case ReportA 13-year-old black girl came to The Brookdale Hospital Medical Center with a one-month history of fever, malaise, arthralgias, vomiting, and weight loss. Several days prior to admission, she complained of blurred vision. The temperature was 38.5 C, pulse 80/min, respiratory rate 24/ min, and blood pressure 120/80 mm Hg. Her skin revealed hyperpigmented confluent lesions on the extensor surface of arms and legs. Results of examination of head, ears, nose, and throat were within normal limits. Her sclerae were injected, and she was photophobic. A slit-lamp examination latter revealed a granulomatous panuveitis. No lymphadenopathy was noted. Examination of her heart and lungs was unremarkable. Her spleen was not palpable but her liver was enlarged 4 cm below the right costal margin. The result of admission neurologic examination was normal. Initial laboratory values were WBC count 8800 with 30% bands, 34% segmented neutrophils, 26% lymphocytes, and 7% eosinophils; hemoglobin 11.0 g; platelets 686,000; and a sedimentation rate of 64 mm/hr; PT 13/13; PTT 44 sec; SGOT 48 U/L; SGPT 29 U/L; CPK 179 U/L; LDH 48-2 U/L; cholesterol 133 mg/dl; calcium 8.8 mg/ dl; phosphorus 2.8 mg/dl; uric acid 4.9 mg/dl; BUN 12 mg/dl; glucose 80 mg/dl; creatinine 1.2 mg/dl; alkaline phosphatase 262 IU; sodium 132 mEq/L, potassium 3.4 mEq/L, chloride 95 mEq/L, CCI~ 25 mEq/L. Her urine was 1 + for protein with 3-5 WBC/hpf. Results of latex fixation and screening anti-nuclear antibody tests were negative. A normal chest x-ray and liver scan were also obtained. Pulmonary function testing revealed a severely reduced vital capacity of 30 per cent of predicted value. Diffusion capacity by steady state method was also 30 per cent of predicted. Systemic sarcoidosis was suspected but a conjunctival and liver biopsy were negative.With an empirical diagnosis of sarcoidosis, treatment was begun with systemic therapy of 40 mg of prednisone daily, and she was discharged. At home she continued to have nausea, anorexia, weight loss, headache, and arthralgia. Two weeks later she was readmitted with head nodding and persistent twitching of the right side of her face and right arm. An electrc~encephalogram showed sharp wave build-up in the left midtemporal area leading to generalized seizure activity. A CT scan was normal. Lumbar puncture revealed I WBC/hpf with a CSF protein of 49 mg/l. The diagnosis of systemic sarcoidosis was confirmed by skin biopsy (Fig. 1) which showed a noncaseating granuloma. No
Continuing medical education is being conducted in many overseas sites. The physician who contemplates such trips should be prepared for the more common medical emergencies which may occur to him, his family, or other travelers on such trips. Dr Irving Weinstock, an experienced pediatrician and traveler on such educational programs, has provided a short list of items that he considers useful. Since this journal is dedicated to successful continuing pediatric education, being so prepared may help. R.J.H. In preparing for an overseas trip, I have found it useful to include the pharmaceuticals and medical supplies listed in the Table. The journey will be more enjoyable and pleasant, knowing that you are prepared for most contingencies.
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