Discussion: Sarcoidosis is a multisystem disorder characterized by non-caseating granulomatous inflammation. Neurologic complications occur in approximately 5% of patients, however sarcoidosis with spinal cord involvement is very rare, affecting less than 1% of patients. Here we present a patient with a history of malignancy found to have leptomeningeal enhancements on spinal imaging. Although the clinical picture was initially consistent with cancer, the patient was ultimately found to have biopsy-proven sarcoidosis. In this case, there were several reasons to not immediately consider spinal cord sarcoidosis. Given her history of DCIS, leptomeningeal enhancements were immediately suspicious for malignancy. Secondly, although the patient endorsed leg weakness, the patient’s fall history suggested trauma as a reasonable explanation. In fact, the reason for her falls was initially the more salient question, and prompted the brain MRI. Spinal imaging was added with the goal of simultaneously evaluating her paresthesias. For these reasons, the diagnosis of spinal cord neurosarcoidosis initially seemed improbable.
Conclusions: Dizziness associated with fall is a common problem encountered by the hospitalist. Such patients should be evaluated for a broad range of differential diagnoses including neurosarcoidosis. Specifically, spinal cord sarcoidosis should be considered in the differential for leptomeningeal enhancements, especially in a patient presenting with paresthesias or weakness, with lymphadenopathy on imaging. Given the highly invasive nature of neural tissue biopsy, an evaluation for extraneural sarcoidosis should be performed (i.e. lymph node biopsy). Prompt treatment with corticosteroids is important to limit long-term morbidity from this disease.
To cite this abstract:Tufano, A; Sugarman, R; Berkowitz, JC; Ahmad, SE . WHEN CANCER ISN’T THE ANSWER: NEUROSARCOIDOSIS MASQUERADING AS MALIGNANCY IN A PATIENT WITH HISTORY OF BREAST CANCER. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 761. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/when-cancer-isnt-the-answer-neurosarcoidosis-masquerading-as-malignancy-in-a-patient-with-history-of-breast-cancer/. Accessed February 21, 2020.