A 62-year-old male presented to our clinic with recurrent fever, skin lesions (petechiae),
scleral wounds, and hilar adenomegaly. A diagnosis of sarcoidosis was established,
which resolved with corticosteroid treatment. After a few months, the patient developed
confusion and behavioral changes, with few objective neurological deficits. Brain
magnetic resonance imaging showed slight focal meningeal enhancement (prepontine region).
The level of angiotensin-converting enzymes was normal in the serum and increased
in the cerebrospinal fluid. The patient was diagnosed with neurosarcoidosis, and corticosteroid
treatment was prescribed, yielding good clinical response. Nine months later, the
patient presented with multiple ischemic strokes, and arteriography demonstrated multiple
distal irregularities in all arterial territories, suggesting cerebral vasculitis.
Even with corticosteroids, cyclophosphamide, and intravenous immunoglobulin, the patient
died. Vasculitis is rarely seen in association with sarcoidosis, and in this case,
no systemic manifestation was observed at the time that the patient developed vasculitis.
Key Words
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Article info
Publication history
Published online: April 12, 2016
Accepted:
February 26,
2016
Received in revised form:
November 20,
2015
Received:
September 23,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.02.036
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
