Abstract
A 28 year-old woman with facial nerve palsy was admitted to a hospital in Feb. 2003. Facial palsy was improved by corticosteroid therapy, but in May 2003, she was admitted to Fukuoka University Hospital because of her uveitis and the swelling of bilateral hilar lymphnodes found on a chest radiograph. She was diagnosed as having sarcoidosis of an incomplete form of Heerfordt symptom-complex, incomplete form, based on the following findings: Negative PPD skin test, raised serum γ-globulin, increased ratio of CD4/CD8 in bronchoalveolar lavage fluid, and transbronchial lung biopsy showing noncaseous epithelioid cell granuloma. She was then observed without corticosteroid in the outpatient clinic, and hilar lymph node swelling was improved. In Sept. 2004, skin eruptions appeared on bilateral cubital joints and face. Biopsy of the eruption on the right cubital joint was positive for epithelioid cell granulomas. In Nov. 2004, she noticed pain of the right foot and MIP joint. In Jan. 2005, she noticed increased fever, head neuralgia, and submandibular lymphnode swelling, and was re-hospitalized. Head MRI revealed central nervous system sarcoidosis, and she was treated with 60mg of oral predonisolone a day. Central nervous system sarcoid has been improving. Classification, diagnosis and treatment of neurosarcoidosis referring to previous literature are herein stated with this case report.
