Probable neurosarcoidosis presenting as acute on chronic otorrhoea: a difficult diagnosis

被引:0
作者
Somani, Shaan N. [1 ]
Schneider, Alexander L. [1 ]
Welch, Kevin C. [1 ]
Alexiev, Borislav A. [2 ]
Matsuoka, Akihiro J. [1 ,3 ,4 ]
机构
[1] Northwestern Univ, Feinberg Sch Med, Dept Otolaryngol Head & Neck Surg, Chicago, IL 60611 USA
[2] Northwestern Univ, Feinberg Sch Med, Dept Pathol, Chicago, IL 60611 USA
[3] Northwestern Univ, Dept Commun Sci & Disorders, Evanston, IL 60208 USA
[4] Hugh Knowles Ctr Clin & Basic Sci Hearing & Its D, Evanston, IL 60208 USA
关键词
neurootology; rheumatology; otolaryngology; ENT; head and neck surgery; otitis; SARCOIDOSIS; PACHYMENINGITIS; HEAD; NECK;
D O I
10.1136/bcr-2020-237676
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
An elderly African American woman presented to our clinic following 9months of right-sided unilateral headache, otorrhoea and progressive hearing loss. Despite treatment with topical and oral antibiotics, her clinical condition worsened, and imaging showed mastoid coalescence with an associated subgaleal abscess. She underwent right mastoidectomy and was discharged 3days later on broad-spectrum intravenous antibiotics despite negative operative cultures. Six weeks later, she was hospitalised with diplopia secondary to a right lateral rectus palsy. Imaging showed abscess resolution but progressive bony remodelling and enhancement of the lateral extending into anterior skull base. Chest CT demonstrated upper lobe predominant pulmonary micronodules, and mastoid biopsy on revision surgery was notable for non-caseating granulomas. Further extensive work-up could not identify an alternative cause, and a presumptive diagnosis of neurosarcoidosis was made. The patient was initiated on intravenous steroids, experienced symptomatic improvement and was thereafter transitioned to oral steroid taper on discharge.
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