Spinal Predominant Neuro-Sarcoidosis Revealing Previously Undiagnosed Systemic Sarcoidosis: A Rare Presentation
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-8-2026
Abstract
Neuro-sarcoidosis affects approximately 5-10% of patients with systemic sarcoidosis, with spinal cord involvement occurring in fewer than 1%. While spinal neuro-sarcoidosis is typically described as discrete radiographic phenotypes, either intramedullary myelitis or leptomeningeal disease, the clinical significance of extensive, overlapping multilevel leptomeningeal and intramedullary spinal involvement remains poorly characterized. We present a case of aggressive spinal-predominant neuro-sarcoidosis revealing the previously undiagnosed systemic sarcoidosis.
A 71-year-old woman presented with diplopia, speech difficulties, and progressive left-sided weakness following a recent admission where she received C4-C6 cervical fusion for worsening gait instability and falls initially attributed to cervical spinal stenosis. MRI demonstrated extensive multilevel nodular leptomeningeal enhancement involving the cerebellum, brainstem, and spinal cord, with concurrent intramedullary enhancing lesions and multifocal T2 hyperintensity throughout the spinal cord. CSF revealed lymphocytic pleocytosis, elevated protein, IgG index with mirrored oligoclonal bands, and serum soluble IL-2 receptor levels along with low glucose; otherwise, infectious, autoimmune, and malignant studies were negative. Systemic imaging identified mediastinal and hilar lymphadenopathy, spinal, and hepatic lesions. Bronchial biopsy confirmed non-caseating granulomatous inflammation, establishing a diagnosis of biopsy-supported systemic sarcoidosis with concomitant neuro-sarcoidosis.
This case highlights a rare spinal-predominant presentation of neuro-sarcoidosis that led to the diagnosis of systemic sarcoidosis. The patient underwent cervical fusion without symptomatic improvement, underscoring how overlapping radiographic findings may obscure diagnosis when neuro-sarcoidosis is the initial manifestation of previously unrecognized systemic disease. Increased recognition of this phenotype is critical to enable timely diagnosis and initiation of immunosuppressive therapy, which may improve neurologic outcomes in severe spinal neuro-sarcoidosis.
Recommended Citation
Mitchell A, Bustamante E, Marsia S, Cencer S, Lannen N. Spinal predominant neuro-sarcoidosis revealing previously undiagnosed systemic sarcoidosis: A rare presentation. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.
Comments
2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2093