Neurosarcoidosis diagnosed during pregnancy by thoracoscopic lymph node biopsy. A case report.
BACKGROUND
Sarcoidosis is a multiorgan-system granulomatous disease causing respiratory complaints in most patients. Eye involvement, most commonly granulomatous uveitis, is seen in 5% of black patients with sarcoidosis. Neurosarcoidosis is also rare, affecting 5% of patients with sarcoidosis. Thoracoscopic lymph node biopsy in pregnancy has never before been reported.


METHODS
An otherwise-healthy, 25-year-old woman, gravida 2, para 1001, presented at 25 weeks' gestation with a painful facial palsy and visual defects. Ophthalmologic examination revealed uveitis, and a chest radiograph revealed asymmetric hilar adenopathy. At 28 weeks' gestation, the patient underwent thoracoscopic lymph node biopsy, which confirmed the diagnosis of sarcoidosis. The symptoms were stabilized with therapeutic corticosteroids, and the patient delivered a healthy neonate at term.


CONCLUSIONS
The diagnosis of sarcoidosis remains one of exclusion and requires a high index of suspicion. Tissue confirmation is often necessary, especially when patients have extrathoracic complaints. For patients without other lesions amenable to biopsy, thoracoscopic lymph node biopsy can be considered despite pregnancy.
Cardonick
E H
EH
Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Naktin
J
J
Berghella
V
V
D001706:Biopsy; D003937:Diagnosis, Differential; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000473:pathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000473:pathology; D012507:Sarcoidosis / Q000175:diagnosis* / Q000473:pathology; D013906:Thoracoscopy; D014605:Uveitis / Q000209:etiology