SHM Converge Scientific Abstract ePoster Gallery-Pulling the Thread Leading to the Uncommon: Unmasking Neurosarcoidosis

Pdf Summary

This case report describes a 42-year-old African American man with persistent nausea, vomiting, vertigo, and abdominal pain after cholecystectomy. Although initial abdominal imaging showed only a small pneumoperitoneum, further evaluation revealed bidirectional nystagmus and papilledema. Brain MRI demonstrated severe communicating hydrocephalus with leptomeningeal enhancement, raising concern for meningitis, malignancy, or other inflammatory disease.<br /><br />Lumbar puncture showed markedly elevated opening pressure, lymphocytic pleocytosis, high protein, and low glucose. MRI of the spine showed diffuse nodular enhancement. An extensive infectious and malignancy workup was negative. Given the clinical picture and imaging findings, the team diagnosed presumptive neurosarcoidosis, meeting “possible” consensus criteria despite lack of definitive biopsy confirmation. Treatment was started with high-dose prednisone and cyclophosphamide. Because intracranial pressure remained elevated, a ventriculoperitoneal shunt was placed. A leptomeningeal biopsy did not show malignancy, and symptoms resolved. The patient was discharged on a prednisone taper, monthly cyclophosphamide infusions, and close follow-up.<br /><br />The report emphasizes that neurosarcoidosis is rare, occurs in only a small subset of sarcoidosis patients, and can mimic infection, malignancy, demyelinating disease, or meningitis. Diagnosis is challenging and often depends on excluding alternative causes while integrating clinical, radiographic, and CSF findings. Although biopsy is the gold standard, it is not always diagnostic. Early recognition is important because immunosuppressive therapy, especially glucocorticoids and steroid-sparing agents, can improve outcomes, though treatment failures are common.

Asset Subtitle

Cole Bourgeois

Meta Tag

Author List Bruno Álvarez Concejo, Cole Bourgeois, Yazan Hijazein

Category Clinical Vignettes

Concept Neurosarcoidosis

Concept Hydrocephalus

Concept Leptomeningeal Disease

Concept Optic Neuritis

Concept Seizure

Distinguished Non-Finalist

Presenter Organization LSU Health Shreveport

Presenting Author Cole Bourgeois

Track Adult

Keywords

neurosarcoidosis

communicating hydrocephalus

leptomeningeal enhancement

papilledema

lymphocytic pleocytosis

elevated intracranial pressure

ventriculoperitoneal shunt

prednisone

cyclophosphamide

case report

Neurosarcoidosis

Hydrocephalus

Leptomeningeal Disease

Optic Neuritis

Seizure