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Washington University Experience | MISCELLANEOUS | Neurosarcoid - no PNS | 1A0 Case 1 History
Case 1 History ---- The patient was a 41-year-old man with a 3 year history of neurosarcoidosis, panhypopituitarism, diabetes, hypertension and chronic left optic neuropathy. He was diagnosed based on leptomeningeal enhancement in his brain and spine and biopsy findings of noncaseating granulomas. He was treated with i.v. methylprednisolone and, later transitioned to oral prednisone with weekly methotrexate as an outpatient. There were also numerous small enhancing nodules with associated T2/FLAIR hyperintensity thought to be related to known history of neurosarcoidosis or infectious leptomeningitis or encephalitis. He was reported to have fallen and developed a headache associated with nausea, vomiting, photophobia, and phonophobia. One day prior to his hospital visit, he developed hallucinations. He was noted to have a non-focal neurologic exam but nonsensical speech at an outside hospital. Urine drug screening was negative. The patient continued to have facial twitching despite AED, Keppra loads with continued seizures. A dose of 1 mg Ativan and Fospheny was loaded and, shortly thereafter, the patient was found to be pulseless and breathless and could not be revived.
