Rapid-Onset Thoracic Myelopathy due to an Epidural Sarcoid-Like Lesion in a Pediatric Patient

Galgano, Michael A.; Goulart, Carlos R.; Chisholm, Karen M.; Hazen, Melissa; Stone, Scellig

doi:10.1016/j.wneu.2017.12.185

Cited by 9 publications

(12 citation statements)

References 27 publications

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“…Our review of the literature returned four cases of epidural neurosarcoidosis causing neurological deficits, each presenting as myelopathy without systemic manifestations of sarcoidosis. These confirmed cases of epidural neurosarcoidosis causing spinal cord compression required surgical intervention to forestall the disease [2, 8, 15, 16].…”

Section: Discussionmentioning

confidence: 77%

“…Similarly, diagnosis was confirmed by histopathology showing sarcoid granulomas [16]. The final case in the current literature was of a nine-year-old girl with an epidural lesion reported by Galgano et al [8]. They describe a patient with recurrent epidural disease requiring multiple surgeries who presented with myelopathy secondary to a thoracic lesion.…”

Section: Discussionmentioning

confidence: 94%

“…A presumptive diagnosis of epidural neurosarcoidosis was made due to granulomatous inflammation on biopsy specimens and a significant response to corticosteroids. The authors note that other pathologies cannot, however, be ruled out [8].…”

Section: Discussionmentioning

confidence: 99%

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Multifocal Epidural Neurosarcoidosis Causing Spinal Cord Compression: A Case Report

Longo¹,

Gelfand²,

Kinon³

et al. 2019

Cureus

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We describe a rare case of multifocal extramedullary epidural neurosarcoidosis that presented with myelopathy without motor deficits and perform a literature review for previous cases of epidural neurosarcoidosis. A 46-year-old woman presented with lower back pain, urinary incontinence, gait disturbance, and sensory loss without motor deficits. Spine magnetic resonance imaging (MRI) showed multiple epidural lesions, the largest causing spinal cord compression at the T5 level. A computed tomography (CT)-guided biopsy of the dominant lesion showed noncaseating granulomas consistent with neurosarcoidosis. She was treated with a course of dexamethasone and discharged home after a 10-day hospital course. She was discharged home on oral prednisone taper over a four-month period. At her latest follow-up, she is neurologically intact and gainfully employed. This case demonstrates that certain cases of epidural neurosarcoidosis causing spinal cord compression may be treated with medical therapy alone in the absence of severe neurological deficits.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 94%

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Multifocal Epidural Neurosarcoidosis Causing Spinal Cord Compression: A Case Report

Longo¹,

Gelfand²,

Kinon³

et al. 2019

Cureus

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“… 5 We identified 13 additional cases (counting ours) not listed in that review. 6 - 17 Symptoms tend to differ based on the age of presentation; seizures are more common in younger children, whereas cranial nerve palsies predominate in older children and adolescents. 2 Hypothalamic/pituitary dysfunction, headaches, meningismus, central nervous system mass lesions, and peripheral neuropathies are other manifestations that can occur across all ages.…”

Section: Discussionmentioning

confidence: 99%

Pituitary Sarcoidosis in a Pediatric Patient Successfully Treated With Adalimumab and Methotrexate

Villacis-Nunez

Thakral

2021

Journal of Investigative Medicine High Impact Case Reports

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Neurosarcoidosis is a rare phenomenon in the pediatric population, with only a few cases reported in the literature worldwide. While hypothalamo-pituitary involvement is known to occur, direct infiltration of the pituitary gland and isolated anterior pituitary dysfunction without diabetes insipidus is seldom observed. A high index of suspicion is required for diagnosis of neurosarcoidosis, and treatment can be challenging due to lack of standardized guidelines. We present the case of a 17-year-old female with known sarcoidosis of the lacrimal glands, who developed severe headache and neurologic symptoms secondary to granulomatous infiltration of the pituitary gland and infundibulum due to neurosarcoidosis. She was successfully treated with corticosteroids, methotrexate, and adalimumab, with complete radiologic resolution. This is the first documented pediatric case of neurosarcoidosis with radiologic granulomatous infiltration of the pituitary gland, manifesting as partial anterior hypopituitarism, in the form of central hypothyroidism, without diabetes insipidus.

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“…Of interest, most are intramedullary lesions, and few involve the extradural compartment [ Table 1]. [2,5,6] Most cases of neurosarcoidosis have normal levels of ACE, and the histology demonstrates nonnecrotizing granulomas with an inflammatory background [ Table 1]. [1,7,8] Paglia et al, 2019 [6] Back pain, lower limbs weakness, and paraesthesia…”

Section: Discussionmentioning

confidence: 99%

Cervical epidural neurosarcoidosis: A case report and literature review

Khairy

Alharbi

Alaglan

et al. 2020

Surgical Neurology International

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Background: Neurosarcoidosis is a rare disease. In the spine, it commonly presents as an intramedullary lesion. Epidural spinal lesions are extremely rare. Case Description: A 29-year-old patient presented with a 22-month history of progressive neck, upper limb pain, and myelopathy. The cervical MRI showed a large epidural mass infiltrating the paraspinal soft tissue. After an open biopsy, the diagnosis of neurosarcoidosis was established and was followed-up by appropriate medical management. Conclusion: To manage cervical epidural neurosarcoidosis, first, you must obtain a tissue diagnosis and then follow with appropriate medical management.

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Rapid-Onset Thoracic Myelopathy due to an Epidural Sarcoid-Like Lesion in a Pediatric Patient

Cited by 9 publications

References 27 publications

Multifocal Epidural Neurosarcoidosis Causing Spinal Cord Compression: A Case Report

Multifocal Epidural Neurosarcoidosis Causing Spinal Cord Compression: A Case Report

Pituitary Sarcoidosis in a Pediatric Patient Successfully Treated With Adalimumab and Methotrexate

Cervical epidural neurosarcoidosis: A case report and literature review

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