The Journal of Clinical Pediatric Rheumatology
Online ISSN : 2434-608X
Print ISSN : 2435-1105
Isolated neurosarcoidosis with initial onset of facial paralysis in a boy
Shoko FurukawaYoshihiko SakuraiNobuyuki EuraYoshitaka KitauchiMakoto KawaharaSatoshi UenoMidori Shima
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JOURNAL FREE ACCESS

2010 Volume 3 Issue 1 Pages 33-37

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Abstract

Neurological involvement is rare in sarcoidosis, and isolated neurosarcoidosis without any other organ involvement is often difficult to diagnose. We report the case of an 11-year-old boy who was clinically diagnosed with isolated neurosarcoidosis. Right facial nerve paralysis developed in the patient 2 months before admission. Although oral corticosteroid produced partial improvements in facial palsy, decreased visual acuity was identified 2weeks before admission. He saw an ophthalmologist and was diagnosed with acute optic neuritis l week before admission. Continuous oral corticosteroids failed to improve visual acuity. Following additional development of photophobia and paresthesia of the lower leg, he was admitted to our hospital for detailed investigations. Examination of the visual field revealed bitemporal inferior quadrantanopia, suggesting damage to the optic chiasm. We failed to obtain positive examination findings for general reactions, but magnetic resonance imaging (MRI)of the brain revealed signal hyperintensities on T2-weighted imaging and gadolinium enhancement in the posterior optic nerve and chiasm. No tissue diagnosis was made because of the difficulty of intracranial biopsy. After considering differential diagnoses, a clinical diagnosis of isolated neurosarcoidosis was made on the basis of clinical and imaging findings. Methylprednisolone pulse therapy was initiated, achieving gradual improvements in right facial palsy and visual acuity This case suggests the usefulness of diagnostic imaging with MRI for diagnosing and making therapeutic decisions for isolated neurosarcoidosis.

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© 2010 Pediatric Rheumatology Association of Japan
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