Mercan Metin, Akyol Aslı, Karaman Yahya, Bolay Hayrunnisa
Department of Neurology, Gazi University Faculty of Medicine, 06410 Ankara, Turkey.
Case Rep Med. 2015;2015:403459. doi: 10.1155/2015/403459. Epub 2015 Feb 25.
Sarcoidosis is a multisystemic disease characterized by granulomatous inflammation. Lung or lymph node involvement is common. We present a rare case of sarcoidosis that began with orbital involvement, and a month later, due to insufficient treatment, it involved the central nervous system. A 49-year-old female patient began suffering from swelling in her right eye, redness, ptosis, and limited eye movements two months ago. Gadolinium-enhanced orbital magnetic resonance imaging showed thickening of the lacrimal gland and the right medial rectus muscle. After three weeks of local antibiotic and steroid treatments, her symptoms were resolved. One month ago, the patient reported sudden weakness in her right arm and leg. After laboratory tests and imaging studies, the patient was diagnosed with probable neurosarcoidosis using the Zajicek criteria and treated with prednisone (1 mg/kg/day). Although sarcoidosis frequently presents with lung and lymph node involvement, it is rarely accompanied by orbital involvement. Patients with orbital symptoms may receive a late diagnosis and insufficient central nervous system treatment. Involvement of the central nervous system in sarcoidosis leads to high morbidity and mortality rates. Therefore, early diagnosis and treatment are very important.
结节病是一种以肉芽肿性炎症为特征的多系统疾病。肺部或淋巴结受累较为常见。我们报告一例罕见的结节病病例,该病例始于眼眶受累,一个月后,由于治疗不充分,累及中枢神经系统。一名49岁女性患者两个月前开始出现右眼肿胀、发红、上睑下垂和眼球运动受限。钆增强眼眶磁共振成像显示泪腺和右侧内直肌增厚。经过三周的局部抗生素和类固醇治疗,她的症状得到缓解。一个月前,患者报告右臂和右腿突然无力。经过实验室检查和影像学研究,根据扎伊切克标准,该患者被诊断为可能的神经结节病,并接受泼尼松(1毫克/千克/天)治疗。虽然结节病常表现为肺部和淋巴结受累,但很少伴有眼眶受累。有眼眶症状的患者可能会得到较晚的诊断且中枢神经系统治疗不充分。结节病累及中枢神经系统会导致高发病率和死亡率。因此,早期诊断和治疗非常重要。