SHM Converge Scientific Abstract ePoster Gallery-On Pins and Needles: a Case of Small-Fiber Peripheral Neuropathy Due to Neurosarcoidosis

Pdf Summary

A 29-year-old previously healthy man presented with 3 weeks of paresthesias, fatigue, weight loss, and autonomic symptoms including sweating, urinary urgency, constipation, and erectile dysfunction. Neurologic exam showed impaired pain and temperature sensation in both lower extremities, while strength, reflexes, proprioception, and cranial nerves were preserved. Labs revealed elevated ESR and CRP, and cerebrospinal fluid showed lymphocytic pleocytosis with mildly elevated protein.<br /><br />MRI of the spine demonstrated an intramedullary cord lesion extending from C3 to T2, and brain MRI showed nonspecific abnormalities involving cranial nerves, subarachnoid space, ventricles, and orbits. CT chest revealed bilateral hilar and mediastinal lymphadenopathy. Based on these findings, neurosarcoidosis was diagnosed. Cardiac and ocular evaluations were negative for organ involvement.<br /><br />He was treated initially with IV methylprednisolone followed by oral prednisone, but symptoms worsened during tapering. Repeat spine MRI showed decreased lesion size after treatment. A bronchoscopy with hilar lymph node biopsy confirmed the diagnosis by showing non-caseating granulomas. Because of persistent/recurrent neurologic symptoms, treatment was escalated to include methotrexate and infliximab, along with symptomatic medications such as gabapentin and baclofen and supportive rehabilitation.<br /><br />The presentation highlights small-fiber neuropathy as a manifestation of neurosarcoidosis, which can cause sensory and autonomic symptoms and is often difficult to diagnose. MRI and CSF findings are helpful, but tissue pathology remains the diagnostic gold standard. First-line therapy is glucocorticoids, with steroid-sparing immunomodulators used for refractory disease.

Asset Subtitle

Kirsten M. Lipps

Meta Tag

Author List Kevin McKown, Kirsten M. Lipps

Category Clinical Vignettes

Concept Neurosarcoidosis

Concept Sarcoidosis

Concept Small Fiber Neuropathy

Concept Tissue Biopsy

Concept Noncaseating Granuloma

Distinguished Non-Finalist

Presenter Organization University of Wisconsin Hospital & Clinics

Presenting Author Kirsten M. Lipps

Track Adult

Keywords

neurosarcoidosis

small-fiber neuropathy

intramedullary spinal cord lesion

autonomic dysfunction

lymphocytic pleocytosis

non-caseating granulomas

hilar lymphadenopathy

corticosteroid therapy

methotrexate

infliximab

Neurosarcoidosis

Sarcoidosis

Small Fiber Neuropathy

Tissue Biopsy

Noncaseating Granuloma