Neurolymphomatosis mimicking neurosarcoidosis: a case report
IntroductionBoth neurosarcoidosis and central nervous system lymphoma can be very difficult to diagnose. We describe the case of a patient in whom neurosarcoidosis was strongly suspected, but who was eventually found to have lymphoma.
We believe the case to be of interest and practical value to neurologists, oncologists and internists with an interest in inflammatory diseases.Case presentationA diagnosis of neurosarcoidosis was considered in a 49-year-old Caucasian man on the basis of the following symptoms and indications: a cough, bilateral hilar lymphadenopathy confirmed by thoracic computed tomography, the development of an S1 radiculopathy, cerebrospinal fluid abnormalities (raised protein level), bilateral lung hilar and lachrymal gland uptake on a gallium scan, and erythema nodosum confirmed with skin biopsy. These were followed by the development of multiple cranial neuropathies, including seventh nerve palsy.
Exhaustive further investigations yielded no evidence for an alternative diagnosis. Treatments with steroids, cyclophosphamide, intravenous immunoglobulin and finally infliximab were of no benefit.
He eventually developed cutaneous nodules, a biopsy of which revealed lymphoma that proved resistant to therapy.
Conclusion: Constant diagnostic vigilance is required in disorders such as neurosarcoidosis.
Author: Ernestina SantosNeil Scolding
Credits/Source: Journal of Medical Case Reports 2010, 4:5
Published on: 2010-01-12
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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