Open AccessPolyradiculoneuropathy and encephalitis secondary to sarcoidosis in young patient
Author(s) -
Clara Kimie Miyahira,
Beatriz Medeiros Correa,
Raphael Palomo Barreira,
Thomas Zurga Markus Torres,
Nahir Miranda,
Natasha Soares Cutolo,
Thiago da Cruz Marques,
Vanessa Moraes Rossette,
Eduardo de Almeida Guimarães Nogueira
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.288
Subject(s) - medicine , neurosarcoidosis , sarcoidosis , brain biopsy , aseptic meningitis , vasculitis , context (archaeology) , methylprednisolone , encephalitis , pathology , surgery , biopsy , meningitis , immunology , disease , paleontology , virus , biology
Context: Neurosarcoidosis is common in 50-70% of cases of sarcoidosis, but polyradiculoptia in sarcoidosis is rare in 1.3% of cases. Case Report: a 48-year- old woman diagnosed with Sarcoidosis after skin, evolved with sporadic paresthesia of the lower limbs. The use of Methotrexate controlled the disease. However, she developed acute pancreatitis secondary to the treatment and suspended it. After 2 months, the patient presented paraparesis. In view of probable polyradiculoneuropathy, Human Immunoglobulin was administered. However, she evolved with mental confusion, flaccid tetraparesis and global arreflexia. CT of skull showed paramedian bridge hypodensity and left cerebellum, suggestive of vasculitis, and normal liquor. Methylprednisolone was administered. And despite the treatment, patient worsened with decreased level of consciousness and respiratory failure. MRI of skull showed hypersignal in bilateral temporal region, suggesting viral encephalitis secondary to immunosuppression, after methylprednisolone and immunoglobulin. Thus, Aciclovir was administered and there was improvement in the use of BIPAP. Discussion: Other differential diagnoses were considered: Guillain-Barré syndrome, inflammatory and chronic demyelinating polyneuropathies, spirochete infections, fungi or toxoplasmosis. The diagnosis of neurosarcoidosis is mainly due to MRI, high sensitivity and low specificity. Neural tissue biopsy is gold standard, but difficult to access. Conclusion: This clinical history shows an atypical involvement of the Central and Peripheral Nervous System for sarcoidosis: a viral encephalitis after polyradiculopathy and vasculitis treated.