Spinal cord sarcoidosis: report of seven cases |
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Authors: | L Varron C Broussolle J-P Candessanche R Marignier H Rousset J Ninet P Sève |
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Institution: | Hospices Civils de Lyon, Universitéde Lyon 1, Lyon, France;;and Centre Hospitalier Universitaire de Saint Etienne, UniversitéJean Monnet, Saint-Étienne, France |
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Abstract: | Background: Spinal cord involvement in sarcoidosis is rare, occurring in <1% of patients with sarcoidosis. Methods: We report seven cases of spinal cord sarcoidosis, seen in two French hospitals over a 13-year period. Presentation of disease, methods of diagnosis and response to treatment, with quantification according to the reduction of the modified Rankin scale (MRS), were noted. Results: Six patients presented insidious paresthesias or weakness and one a sudden paraplegia. Average MRS at diagnosis was to 2. Spine MRI showed one or several intramedullary lesions in all cases. Diagnosis was confirmed by extra-neural tissue biopsies in all cases, including mediastinoscopy (two patients), coelioscopy (one patient), bronchoscopy (one patient), salivary gland biopsy (one patient) and skin biopsy (two patients). The average follow-up for the group was 49.4 months. All patients responded to corticosteroid therapy with a median reduction of MRS of one point. Five patients received immunosuppressive therapy: cyclophosphamide (two patients), methotrexate (two patients), azathioprine (one patient), mycophenolate mofetyl (one patient), with an inconstant benefit. Patients who received cyclophosphamide presented severe fungaemia. Conclusion: Based on our study and literature analysis, we propose an algorithm for treatment of spinal cord sarcoidosis. |
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Keywords: | immunosuppression neurosarcoidosis spinal disease |
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