Abstract
A 44-year old woman was admitted to the department of orthopedic surgery in Tsubame Rosai Hospital on the suspicion of pyogenic spondilitis in April 2003. She had suffered from blurred vision, general fatigue, and severe back pain since December 2002. Serum C-reactive protein level and spinal MRI findings were normal, although mononuclear cell numbers in the cerebrospinal fluid were slightly increased. A left inguinal lymph node biopsy revealed non-caseating epithelioid cell granuloma in the Department of Hematology, and the diagnosis of sarcoidosis was confirmed in the Department of Respirology, making reference to negative PPD test, high titer of serum angiotensin converting enzyme (ACE), bilateral uveitis, and chest radiographic findings. When facial nerve palsy appeared, she was transferred to Niigata University Hospital. She had left hypochondriac pain resistant to oral pain relievers. Physical and neurological examinations confirmed the swelling of superficial lymph nodes, bilateral parotid glands and left hemihypoesthesia, trigeminal, and facial and auditory nerve findings. Cerebrospinal fluid test showed increases in levels of protein, β 2 microglobulin and ACE. Head MRI findings were normal. 67Ga scintigram demonstrated accumulation in the bilateral pulmonary hilum and parotid glands. From the above-mentioned results, she was diagnosed as having sarcoidosis with central nervous system involvement compatible with Heerfordts syndrome. Sarcoidosis with cranial polyneuropathy often shows high fever and can be associated with pain parallel to dermatome when radiculopathy exists.
