Fluorodeoxyglucose positron emission tomography (FDG-PET) is useful in the diagnosis of neurosarcoidosis.
A 45-year-old man presented with a progressive transverse spinal cord syndrome. MRI scanning revealed bitemporal and multiple spinal lesions with significant enhancement after gadolinium administration mimicking an acute disseminated encephalomyelitis. CSF analyses showed a lymphocytic pleocytosis. After treatment with high dose steroids clinical improvement was observed with a secondary decline shortly thereafter. MRI rescanning showed no remarkable alterations of the lesions. Further diagnostic work-up included a fluorodeoxyglucose positron emission tomography (FDG-PET) of the whole body to search for occult inflammation or neoplasia. The FDG-PET showed hypermetabolic foci corresponding to the lesions on MRI and additionally increased uptake in mediastinal and pulmonary hilar lymph nodes. A mediastinal lymph node was biopsied. Pathology was consistent with the diagnosis of sarcoidosis. The usual diagnostical tools to evaluate a sarcoidosis, such as serum angiotensin converting enzyme (ACE) and computed tomography of the chest were performed initially and revealed no pathological results. Therefore, in this case FDG-PET was crucial for the diagnostic work-up leading to an accessible inflammatory lesion outside the CNS for biopsy and the final diagnosis of sarcoidosis.
Bolat
Seza
S
Department of Neurology, Medical School Hannover, Hannover, Germany. bolat.seza@mh-hannover.de
Berding
Georg
G
Dengler
Reinhard
R
Stangel
Martin
M
Trebst
Corinna
C
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D012507:Sarcoidosis / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D017565:Sarcoidosis, Pulmonary / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D013116:Spinal Cord / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use; D013702:Temporal Lobe / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D019788:Fluorodeoxyglucose F18; D001379:Azathioprine