Abstract
Background
Sarcoidosis is a systemic immune disease with an unknown trigger, identified histologically by non-caseating granulomas. Neurosarcoidosis is a subset in which granulomatous inflammation infiltrates the central or peripheral nervous system. Sarcoid myelopathy affects a very small fraction of sarcoidosis patients. We present here the case of a 35 year old male who presented primarily for cauda equina symptoms.
Case Presentation
A 35-year-old Caucasian male with past history of hypertension, Hashimoto's thyroiditis, and type II diabetes mellitus presented to the emergency department complaining of a headache with left sided face numbness and periorbital swelling. He reported two months of gradual, progressive lower extremity weakness, erectile dysfunction, and bowel and bladder incontinence. Spine MRI found abnormal enhancement of the cervical, thoracic, and lumbar spinal cord. Suspicion for sarcoidosis grew after thorough workup to rule out other etiologies Methylprednisolone one gram daily was started, and the patient rapidly improved over the next five days. A diagnosis of sarcoidosis was confirmed by non-caseating granulomas on hilar lymph node biopsy, and the patient was discharged on maintenance steroid therapy with plans to taper and switch to steroid-sparing therapy.
Discussion
This case presents learning opportunities in its unusual epidemiology, neurological symptoms at presentation, diagnostic complexity, and its treatment course. Neurosarcoidosis is especially rare in young males, and even fewer patients have such debilitating disease. Patients with neurosarcoidosis have highly variable involvement and severity of their diseases, with each case requiring its own diagnostic and treatment plan.
Recommended Citation
Millar B, Carmody L, Naintara F, Dutta T, Hoskote A. Neurosarcoidosis Presenting as Cauda Equina Syndrome: Case Report and Review of the Literature. Transformative Medicine. 2025; 4(2):23-28. doi: https://doi.org/10.54299/tmed/pnfr7021.