神経根障害で発症した神経サルコイドーシスの一例

A５２-year-old woman was referred to our hospital for further examination of thoracolumbar pain. As dysesthesia at Th４level was seen in neurological examination, thoracic radiculopathy or myelopathy was suspected. Blood examination showed elevated level of serum ACE and lysozyme. Lymphadenopathy was evident in bilateral hila and mediastina with marked FDG and Gallium accumulation in FDG-PET-CT and Gallium scintigraphy, respectively. The number of lymphocytes and the CD４／CD８ratio were increased in the BALF. Histological findings of specimens obtained from the lung and the skin lesion revealed noncaseating epithelioid granuloma, which yielded the diagnosis of sarcoidosis. The cerebrospinal fluid examinations showed elevated level of cell counts, proteins and β２-microglobulin. Taken together, she was diagnosed as neurosarcoidosis with thoracic radiculopathy. Her symptoms were improved with oral administration of prednisolone, but they were exacerbated when prednisolone dose was tapered to２０mg／day. Combined therapy of methotrexate and prednisolone was initiated, thereafter her symptoms disappeared completely.

四国医学雑誌 : http://www.tokushima-u.ac.jp/med/research/shikoku_acta_medica.html