Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of meningeal disseminated sarcoidosis with marked hypoglycorrhachia in the CSF

Akihiro Mukaino, M.D.1), Ikuo Kinoshita, M.D.1), Misachi Asai, M.D.1), Fumi Toriyama, M.D.2), Ruka Nakata, M.D.3), Masakatsu Motomura, M.D.3), Takayuki Matsuo, M.D.4) and Tomayoshi Hayashi, M.D., Ph.D.5)

1)Section of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital
2)Section of Dermatology, Japanese Red Cross Nagasaki Genbaku Hospital
3)Department of First Internal Medicine, The Nagasaki University School of Medicine
4)Department of Neurosurgery, The Nagasaki University School of Medicine
5)Department of Pathology, Nagasaki University Hospital

A 29-year-old man diagnosed as having pulmonary sarcoidosis in 2008, and hypothyroidism secondary to thyroidectomy for Basedow's disease was admitted to our hospital with pustular psoriasis in November 2010. He experienced high fever (38°C) and headache in late October 2010. Gadolinium-enhanced T1-weighted image showed multiple micronodular lesions with leptomeningeal enhancement, mainly in the brainstem. Cerebrospinal fluid (CSF) analysis revealed pleocytosis, raised protein level and hypoglycorrhachia (7 mg/dl). The patient was also found to have osteonecrosis of the left femoral head. Antituberculous treatment and steroid pulse therapy were started, but produced no improvement of either the symptoms or the laboratory data. Finally, the patient was diagnosed as having meningeal disseminated sarcoidosis by meningeal biopsy in late March 2011. He was started on treatment with 60 mg prednisolone per day, which resulted in marked clinical improvement. It should be borne in mind that marked hypoglycorrhachia in the CSF can also be seen in meningeal disseminated sarcoidosis.
Full Text of this Article in Japanese PDF (2999K)

(CLINICA NEUROL, 53: 367|371, 2013)
key words: meningeal disseminated sarcoidosis, meningeal biopsy, hypoglycorrhachia, tuberculosis meningitis

(Received: 6-Feb-12)