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27 September 2022 : Case report  USA

An Unusual Presentation of Neurosarcoidosis

Challenging differential diagnosis, Rare disease

Erdal Sarac12ABCDE, Sergul A. Erzurum13ABCDEF, Ali Arif1CDEF*

DOI: 10.12659/AJCR.937125

Am J Case Rep 2022; 23:e937125

Abstract

BACKGROUND: Sarcoidosis is a systemic granulomatous disease of unknown cause, often affecting the lungs and lymphatic system. Neurologic manifestations of sarcoidosis, called “neurosarcoidosis”, can present as cranial neuropathies and occur in an isolated fashion or alongside other systemic findings. These findings occur in about 5% to 15% of individuals, and mainly in women between the ages of 30 and 40 years. Within those subsets of patients who develop neurologic manifestations, ocular manifestations occur 13% to 79% of the time. Less common presentations include secondary glaucoma, intermediate or posterior inflammation, or other neuro-ophthalmic findings.

CASE REPORT: A 63-year-old White man initially presented with blurry vision, acute glaucoma, and other symptoms closely simulating hypertensive retinopathy. He later developed diplopia and was not accurately diagnosed by general ophthalmologists and a retina specialist. Due to the unusual presentation, hypertensive retinopathy was the incorrect initial working diagnosis and the patient continued to develop more severe symptoms. A multidisciplinary approach to patient care through a nephrology referral led to the final diagnosis of neurosarcoidosis. Prompt treatment improved renal function and ocular disturbances.

CONCLUSIONS: Retinal cotton-wool spots, glaucoma, and optic nerve swelling are rare presentations of neurosarcoidosis. Unusual vascular symptoms warrant consideration of all vascular diseases and prompts for collaboration through a multidisciplinary team. This case serves to highlight the importance of sarcoidosis as a differential, even in patients with no previous signs of granulomatous disease, and how a team-based approach between multiple specialties improves accuracy, timeliness, and treatment regimen.

Keywords: Glaucoma, Hypertensive retinopathy, neurosarcoidosis, sarcoidosis

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923