A rare case of sarcoid myelitis complicating Löfgren's syndrome
Main Article Content
Keywords
Sarcoidosis, Neurosarcoidosis, Infliximab, TNF-alfa-inhibitor
Abstract
Neurosarcoidosis is a rare and serious condition. Rapid diagnosis and treatment are crucial to prevent morbidity and mortality. When neurological symptoms are not present at the time of diagnosis, CNS involvement can be undetected. We present a case of neurosarcoidosis complicating Löfgren’s syndrome and discus the challenges in diagnostics and treatment, that can be encountered.
References
1: Baughman RP, Teirstein AS, Judson MA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. AM J Respir Crit Care Med 2001 Nov 15;164(10 pt 1): 1885-9. doi: 10.1164/ajrccm.164.10.2104046.
2: Fritz D, van de Beek D, Brouwer MC. Clinical features, treatment and outcome in neurosarcoidosis: systematic review and meta-analysis. BMC Neurol 2016 Nov 15;16(1):220. doi:/10.1186/s12883-016-0741-x
3: Voortman M, Drent M, Baughman RP. Management of neurosarcoidosis: a clinical challenge. Curr Poin Neurol 2019 Jun; 32(3): 475-483. doi: 10.1097/WCO.0000000000000684.
4: Zajicek JP, Scolding NJ, Foster O, et al. Central nervous system sarcoidosis–diagnosis and management. QJM 1999 Feb;92 (2):103–117. doi: 10.1093/qjmed/92.2.103.
5: Stern BJ, Royal 3rd W, Gelfand JM, et al. Definition and consensus diagnostic criteria for neurosarcoidosis: From the neurosarcoidosis consortium consensus group. JAMA neurol 2018 Dec 1;75(12):1546-1553. doi: 10.1001/jamaneurol.2018.2295.
6: Baughmann RP, Valeyre D, Korsten P, et al. ERS clinical and practice guidelines on treatment of sarcoidosis. Eur Respir J 2021 Dec 16;58(6):2004079. doi: 10.1183/12993003.04079-2020
7: Karakaya B, Kaiser Y, van Moorsel C H M, Grunewald J. Löfgren's Syndrome: Diagnosis, Management, and Disease Pathogenesis; Semin Respir Crit Care Med 2017 Aug;38(4):463-476. doi: 10.1055/s-0037-1602380
8: Kingah P, Alam M, Chugh K, Kamholz J, Samavati L. Role of Pulmonary Evaluation in Diagnosis of Neurosarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2016 Oct 7;33(3):209-215.
9: Raghu G, Remy-Jardin M, J Myers L, et al. Diagnosis of Idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline; Practice Guideline; Am J Respir Crit Car Med 2018 sep 1;198(5):e44-e68. doi: 10.1164/rccm.201807-1255ST.
10: Liam CK, Liam YS, Poh ME, Wong CK. Accuracy of lung cancer staging in the multidisciplinary team setting. Transl Lung Cancer Res. 2020;9(4):1654-66. doi: 10.21037/tlcr.2019.11.28.
11: Bradshaw MJ, Pawate v, Koth LL, Cho TA, Gelfand JM. Neirosarcoidosis. Pathophysiology, Diagnosis and Treatment. Neurol Neuroimmunol Neuroinflamm. 2021 Nov; 8(6): e1084. Doi: 10.1212/NXI.0000000000001084
2: Fritz D, van de Beek D, Brouwer MC. Clinical features, treatment and outcome in neurosarcoidosis: systematic review and meta-analysis. BMC Neurol 2016 Nov 15;16(1):220. doi:/10.1186/s12883-016-0741-x
3: Voortman M, Drent M, Baughman RP. Management of neurosarcoidosis: a clinical challenge. Curr Poin Neurol 2019 Jun; 32(3): 475-483. doi: 10.1097/WCO.0000000000000684.
4: Zajicek JP, Scolding NJ, Foster O, et al. Central nervous system sarcoidosis–diagnosis and management. QJM 1999 Feb;92 (2):103–117. doi: 10.1093/qjmed/92.2.103.
5: Stern BJ, Royal 3rd W, Gelfand JM, et al. Definition and consensus diagnostic criteria for neurosarcoidosis: From the neurosarcoidosis consortium consensus group. JAMA neurol 2018 Dec 1;75(12):1546-1553. doi: 10.1001/jamaneurol.2018.2295.
6: Baughmann RP, Valeyre D, Korsten P, et al. ERS clinical and practice guidelines on treatment of sarcoidosis. Eur Respir J 2021 Dec 16;58(6):2004079. doi: 10.1183/12993003.04079-2020
7: Karakaya B, Kaiser Y, van Moorsel C H M, Grunewald J. Löfgren's Syndrome: Diagnosis, Management, and Disease Pathogenesis; Semin Respir Crit Care Med 2017 Aug;38(4):463-476. doi: 10.1055/s-0037-1602380
8: Kingah P, Alam M, Chugh K, Kamholz J, Samavati L. Role of Pulmonary Evaluation in Diagnosis of Neurosarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2016 Oct 7;33(3):209-215.
9: Raghu G, Remy-Jardin M, J Myers L, et al. Diagnosis of Idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline; Practice Guideline; Am J Respir Crit Car Med 2018 sep 1;198(5):e44-e68. doi: 10.1164/rccm.201807-1255ST.
10: Liam CK, Liam YS, Poh ME, Wong CK. Accuracy of lung cancer staging in the multidisciplinary team setting. Transl Lung Cancer Res. 2020;9(4):1654-66. doi: 10.21037/tlcr.2019.11.28.
11: Bradshaw MJ, Pawate v, Koth LL, Cho TA, Gelfand JM. Neirosarcoidosis. Pathophysiology, Diagnosis and Treatment. Neurol Neuroimmunol Neuroinflamm. 2021 Nov; 8(6): e1084. Doi: 10.1212/NXI.0000000000001084