Sarcoidosis Case with Skin, Kidney and Peripheral Nervous System Involvement

Abstract

Scientific BACKGROUND: Sarcoidosis is a systemic disease where the central nervous system is not commonly involved. Peripheral nerve involvement is also rare. We present a sarcoidosis case with skin, kidney and peripheric nervous system involvement, and discuss the spectrum and mechanism for his neuropathy.

CASE: 57 year-old male patient admitted with skin eruptions and subsequent weakness in his arms and legs. Neurologic examination revealed signs of sensory-motor polyneuropathy. An EMG examination showed axonal sensory and motor polyneuropathy, and mononeuropathy multiplex compatible with conduction block/demyeliniaton. One week, later peripheral facial paralysis developed on both sides, more severe on the left. Subsequently acute renal failure was added. Skin and renal biopsy showed granulomatous infiltrations and sarcoidosis was the diagnose. The patient well responded to high dose steroid therapy.

CONCLUSION: Our case emphasises that sarcoidosis is able to show a broad clinical spectrum (here skin, kidney and nervous system), and also a wide range of peripheral nervous system involvement (distal symmetric axonal polyneuropathy; mononeuropathy multiplex; segmental demyelination/conduction block). We also emphasise that sarcoidosis must be considered in the differential diagnosis in a case with bilateral peripheral facial paralysis