Van Hoye Griet, Willekens Barbara, Vanden Bossche Stephanie, Morrens Manuel, Van Den Eede Filip
Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Department of Neurology, Antwerp University Hospital, Edegem (Antwerp), Belgium.
Front Psychiatry. 2024 Mar 4;15:1276744. doi: 10.3389/fpsyt.2024.1276744. eCollection 2024.
Sarcoidosis is a multisystem non-caseous granulomatous disease of unknown origin with predominant lung involvement and a variable clinical course. Although rare, neuropsychiatric manifestations such as confusion, problems in orientation, memory dysfunction, delusions, hallucinations and catatonia can be presenting features of sarcoidosis with nervous system involvement, also known as neurosarcoidosis.
We present a 39-year-old man with acute-onset vertigo, balance problems and confusion quickly developing delusions, hallucinations, catatonic symptoms and suicidal behaviour. Symptoms appeared to be a manifestation of neurosarcoidosis.
The differential diagnosis of psychosis is broad and should include pertinent auto-immune disorders, paraneoplastic, oncologic, metabolic, and neurodegenerative disorders. Basic systemic screening should include blood and urinary tests, a chest X-ray, brain CT scan and ECG. If neurosarcoidosis is suspected, an MRI of the brain with contrast and lumbar puncture are most appropriate. Multidisciplinary collaboration is essential to arrive at a correct diagnosis and effective management of the patient.
Despite the large number of sarcoidosis and psychosis studies, the etiology and pathogenesis of both illnesses remain incompletely understood. A common inflammatory etiopathological pathway has been postulated.
Clinicians should consider organic causes when confronted with a middle-aged patient experiencing a first psychotic episode with an atypical onset, catatonic features, or dysfunction in orientation and/or memory, a complete lack of a positive familial psychiatric history and/or an atypical response to (psycho)pharmacological treatment.
结节病是一种病因不明的多系统非干酪样肉芽肿性疾病，主要累及肺部，临床病程多变。尽管罕见，但神经精神症状如意识模糊、定向障碍、记忆功能障碍、妄想、幻觉和紧张症等，可作为结节病累及神经系统（即神经结节病）的首发症状。
我们报告一名39岁男性，急性起病，出现眩晕、平衡问题及意识模糊，并迅速发展为妄想、幻觉、紧张症症状及自杀行为。这些症状似乎是神经结节病的表现。
精神病的鉴别诊断范围广泛，应包括相关的自身免疫性疾病、副肿瘤性疾病、肿瘤性疾病、代谢性疾病和神经退行性疾病。基本的系统筛查应包括血液和尿液检查、胸部X线、脑部CT扫描和心电图。如果怀疑是神经结节病，最适宜进行脑部增强MRI和腰椎穿刺检查。多学科协作对于正确诊断和有效治疗患者至关重要。
尽管有大量关于结节病和精神病的研究，但这两种疾病的病因和发病机制仍未完全明确。已推测存在一条共同的炎症性病因病理途径。
当面对一名中年患者首次出现非典型起病、紧张症特征、定向和/或记忆功能障碍的精神病发作，且完全没有阳性家族精神病史和/或对（心理）药物治疗反应不典型时,临床医生应考虑器质性病因。
