Sarcoidosis and spinal cord atrophy

BACKGROUND- This article illustrates a case of spinal cord atrophy in a patient with sarcoidosis. A review of the literature and a causal relationship for the physical and laboratory data will be explored. The patient was diagnosed with sarcoidosis based on chest x-ray and Kveim-Stilzbach skin test results. The patient presented to our hospital with signs and symptoms of myelopathy indicative of thoracic cord pathology. This case is unique because it reveals marked atrophy of the thoracic spine as demonstrated on magnetic resonance imaging (MRI) 3 months after the patient developed neurological symptoms. This case is in contradistinction to earlier published reports in which spinal cord atrophy was identified at least 5 years or more after the onset of neurological symptoms. Our case report suggests that some patients with sarcoid myelopathy either do not go through the initial stages of spinal cord enlargement or do so rapidly. The differentials were discussed and possible mechanisms for our patient's unusual course are examined. Standard MRI, special serum, and spinal fluid specimens were used. REVIEW SUMMARY- The patient was treated with intravenous steroids with gradual improvement. The physical and occupational therapy departments worked with the patient daily, and he was subsequently transferred to a rehabilitation facility. CONCLUSIONS- This article illustrates a patient with sarcoidosis with a rapid onset of neurological symptoms within 3 months and verified atrophy of the spinal cord within 18 months. Previous hypotheses of ischemic degeneration have been postulated and are likely. Now, with widespread use of MRI, further studies should elucidate the pathophysiology of this disorder and the value of early detection and treatment.