Intraspinal epidural sarcoidosis: case report.
OBJECTIVE
A rare case of lumbar intraspinal epidural sarcoidosis is identified. The rarity of this condition and its clinical presentation are stressed.


METHODS
A young Caucasian man presented with the progressive onset of cauda equina syndrome as a result of an expanding mass in the lumbar epidural space compromising the lumbar dural tube from L1 to S1. The patient presented with motor, sensory, and sphincteric dysfunction as a result of this large intraspinal epidural mass. No evidence of systemic illness was noted concomitant with the patient's onset of neurological symptomatology. The patient underwent surgical extirpation of a lumbar intraspinal epidural mass, which was identified histopathologically as sarcoid granuloma. The postoperative work-up included the identification of a mediastinal adenopathy, which was subsequently biopsied and confirmed the diagnosis of sarcoid disease. The patient was treated postoperatively with oral prednisone over a 4-month period. At 7 months postoperatively, the patient had regained gainful employment, the results of his neurological examination were normal, and he was pain-free.


METHODS
The patient underwent a multilevel bilateral lumbar laminectomy with facet preservation, extending from L1 to S1, allowing for a gross total removal of the epidural mass. Postoperative oral prednisone was administered as adjuvant therapy for the treatment of multisystem sarcoid disease.


CONCLUSIONS
Aggressive surgical management involving the removal of an extensive epidural mass of the lumbar canal, which was diagnosed as sarcoid disease, coupled with the adjuvant use of oral prednisone has resulted in an excellent outcome for the patient. The results of his clinical examination are now normal, and postoperative radiological imaging reveals no evidence of recurrent or residual disease in the lumbar epidural space. In the unusual case of intraspinal epidural sarcoidosis, the surgical resection of accessible intraspinal epidural masses is recommended, as is the use of oral prednisone postoperatively.
Weissman
M N
MN
Department of Neurological Surgery, Wausau Hospital Medical Center, Wisconsin, USA.
Lange
R
R
Kelley
C
C
Belgea
K
K
Abel
L
L
D000328:Adult; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004824:Epidural Space / Q000473:pathology / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008297:Male; D009460:Neurologic Examination; D011241:Prednisone / Q000008:administration & dosage; D012507:Sarcoidosis / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*
D011241:Prednisone