title: A Case Report of Neurosarcoidosis Presenting as a Lymphoma Mimic.
abstract: Objective.To describe a unique presentation of neurosarcoidosis.Background.Central nervous system involvement is rare in sarcoidosis. Sarcoidosis can be severe and can be mistaken for systemic lymphoma.Case Description.A 55-year-old right-handed white male with past medical history of obstructive sleep apnea, Raynaud's disease, and Hashimoto's thyroiditis was noted to have cognitive decline over a duration of few weeks and 20 lb weight loss. His neurologic exam (including cranial nerves) was normal except for five-minute recall. Head CT revealed a lacrimal gland mass, confirmed on brain MRI, which was suspicious for lymphoma on brain PET/MRI. Subsequent whole-body FDG PET/CT scan showed multiple enlarged lymph nodes. Bone marrow biopsy was negative. Serum and CSF ACE levels were within normal limits. Supraclavicular lymph node biopsy before steroids therapy was initiated and revealed multiple noncaseating granulomas, diagnostic of "sarcoidosis." He was treated with daily prednisone for two months, followed by weekly infliximab. Brain MRI two months after treatment with prednisone showed decrease in size of lacrimal lesion, and brain PET/MRI showed normal brain metabolism pattern after five months. Neurocognitive evaluation three months after diagnosis demonstrated improvements in memory abilities.Discussion.Both clinically and radiographically, neurosarcoidosis can mimic systemic lymphoma. Biopsy in these types of cases is necessary to establish the diagnosis.
authors: Department of Neurology, Stony Brook University Hospital, Stony Brook, NY, USA.
authors: Gurcharanjeet
authors: 0000-0003-3552-1423
authors: G
authors: Kaur
authors: Department of Neurology, Stony Brook University Hospital, Stony Brook, NY, USA.
authors: Lauren
authors: L
authors: Cameron
authors: Department of Neurology, Stony Brook University Hospital, Stony Brook, NY, USA.
authors: Olga
authors: O
authors: Syritsyna
authors: Department of Neurology, Stony Brook University Hospital, Stony Brook, NY, USA.
authors: Patricia
authors: 0000-0002-3801-6177
authors: P
authors: Coyle
authors: Department of Neurology, Stony Brook University Hospital, Stony Brook, NY, USA.
authors: Agnes
authors: 0000-0003-0576-0423
authors: A
authors: Kowalska