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BMJ Case Reports 2009; doi:10.1136/bcr.11.2008.1187
  • Rare disease

Neurosarcoidosis with necrotising sarcoid granulomatosis mimicking meningiomatosis cerebri: case report and literature search

  1. Natasha M Savage1,
  2. Hemang Shah2,
  3. Cargill H Alleyne3,
  4. Jeffrey A Switzer2,
  5. Jeffrey R Lee1,4,
  6. John Steele1,
  7. Suash Sharma1
  1. 1
    Medical College of Georgia, Pathology, BAE 2571, 1120 15th Street, Augusta, Georgia, 30912, USA
  2. 2
    Medical College of Georgia, Neurology, 1120 15th Street, Augusta, Georgia, 30912, USA
  3. 3
    Medical College of Georgia, Neurosurgery, 1120 15th Street, Augusta, Georgia, 30912, USA
  4. 4
    Veterans Affairs Medical Center, Pathology and Laboratory Medicine Department, 1 Freedom Way, Augusta, Georgia, 30904, USA
  1. Natasha Marie Savage, nsavage{at}mail.mcg.edu
  • Published 25 May 2009

Summary

A 52-year-old woman presented with headaches, difficulty with word finding and left eye blindness. MRI showed enhancing frontal dural-based masses suggestive of meningiomatosis. Biopsy and debulking revealed necrotising granulomas, without discernible micro-organisms or neoplasia; a thorough clinical work-up was negative for infection and vasculitis. A CT scan showed mild bilateral hilar lymphadenopathy, a tiny pulmonary nodule and cirrhotic liver. Her subsequent alteration of mental status was attributed to hepatic encephalopathy based upon elevated aminotransferase and ammonia levels, biopsy evidence of hepatoportal sclerosis with rare granulomas and response to lactulose. A diagnosis of neurosarcoidosis of the necrotising sarcoid granulomatosis variant (NS-NSG) with atypical systemic involvement was made. This is the fifth case report of NS-NSG clinically mimicking a neoplasm and histologically mimicking a mycobacterial infection. NS-NSG can have an atypical clinical picture including intracranial masses; a thorough work-up to exclude infectious and other non-infectious aetiologies is a prerequisite to its diagnosis.

Footnotes

  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.

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