title: Necrotising sarcoid granulomatosis of the spinal cord: case report.
abstract: We report a patient who presented with leg weakness and cervical lymphadenopathy. Thoracical magnetic resonance imaging showed an inhomogenously increased signal in the thickened portion of the cord. Multilevel laminectomy and spinal cord biopsy revealed granulomatous infiltrations with necrosis. Review of the histopathological finding established the diagnosis of necrotising sarcoid granulomatosis (NSG) of the spinal medulla, cytological FNA diagnosis of the neck lymph node was granulomatous inflammation with necrosis, but histopathological analysis of the same neck lymph node disclosed granulomatous inflammation without necrosis. On further radiographic chest evaluation mediastinal lymphadenopathy was found. Immunophenotyping of lymphocytes in bronchoalveolar lavage fluid (BALF) was indicative of sarcoidosis. After the administration of corticosteroid therapy the patient's clinical condition improved, and laryngeal and mediastinal lymph nodes subsided with minor changes remaining in the spinal medulla, which, based upon MR assessment, were considered to be irreversible. To our knowledge, this is the first described case with finding of granulomatous inflammation with and without vasculitis in various organs, consistent with the Churg's study who believes NSG to be a histological variant of sarcoidosis.
authors.affiliation: Division of Internal Medicine, Dubrovnik General Hospital, Dubrovnik, Croatia. zarkov@bolnica-du.hr
authors.forename: Zarko
authors.initials: Z
authors.lastname: Vrbica
authors.forename: Zagorka
authors.initials: Z
authors.lastname: Boras
authors.forename: Neven
authors.initials: N
authors.lastname: Rakusić
authors.forename: Silvana
authors.initials: S
authors.lastname: Smojver-Jezek
authors.forename: Denis
authors.initials: D
authors.lastname: Baricević
authors.forename: Nika
authors.initials: N
authors.lastname: Rakusić
authors.forename: Ivan
authors.initials: I
authors.lastname: Alerić
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology; D013902:Radiography, Thoracic; D012507:Sarcoidosis / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D013116:Spinal Cord / Q000473:pathology* / Q000601:surgery; D013118:Spinal Cord Diseases / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery
chemical_list: D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents