A Unique Case of Sarcoid-associated Myelopathy Accompanied by Lung Cancer

The differential diagnosis of myelopathy in patients with malignancies may be challenging, as a spinal biopsy is not always applicable. A 66-year-old woman who had shown transient double vision and nausea developed spasticity and impaired deep sensation in both feet. Magnetic resonance imaging showe...

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Bibliographic Details
Published in:Internal Medicine 2023/12/01, Vol.62(23), pp.3531-3535
Main Authors: Tadokoro, Koh, Nakada, Yumi, Sasaki, Ryo, Nakano, Yumiko, Yunoki, Taijun, Shin, Kotaro, Taoka, Masataka, Ninomiya, Kiichiro, Nomura, Emi, Takemoto, Mami, Morihara, Ryuta, Yamashita, Toru
Format: Article
Language:English
Subjects:
Aged
Biopsy
Bone Marrow Diseases
Brain stem
Case Report
Central nervous system diseases
Cerebrospinal fluid
Contrast Media
Cytology
Differential diagnosis
Female
Gadolinium
Granuloma
Humans
Internal medicine
Lung cancer
Lung carcinoma
Lung Neoplasms - complications
Lung Neoplasms - diagnosis
Lymph nodes
Magnetic resonance imaging
Malignancy
Meninges
Metastases
Methotrexate
Methylprednisolone
myelopathy
Pleocytosis
Prednisolone
sarcoidosis
Sarcoidosis - complications
Sarcoidosis - diagnosis
Sarcoidosis - pathology
Sensation
Spasticity
Spinal cord
Spinal Cord Diseases - complications
Spinal Cord Diseases - diagnostic imaging
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Summary:The differential diagnosis of myelopathy in patients with malignancies may be challenging, as a spinal biopsy is not always applicable. A 66-year-old woman who had shown transient double vision and nausea developed spasticity and impaired deep sensation in both feet. Magnetic resonance imaging showed abnormal gadolinium enhancement of the brainstem, spinal meninges, and nerve root. Cerebrospinal fluid (CSF) revealed mild pleocytosis and elevated protein and decreased glucose levels, although CSF cytology was normal. Lung carcinoma was simultaneously detected, and noncaseating granuloma was detected from the hilar and axillary lymph nodes, so she was diagnosed with sarcoid-associated myelopathy. Her symptoms were kept stable by intravenous methylprednisolone, oral prednisolone, and methotrexate. This is the first case of sarcoid-associated myelopathy accompanied by lung cancer, suggesting the importance of clinical course, repetitive CSF cytology, and a biopsy of the lymph nodes to distinguish sarcoid-associated myelopathy from meningeal metastasis in patients with malignancies.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.0943-22