Endocrine Abstracts

Sarcoidosis is a multiorgan disease often affecting the lungs and lymphatic system. Neurological involvement occurs in sarcoidosis as granulomas infiltrate the nervous system. Here, we present a case of neurosarcoidosis diagnosed following non-specific neurological symptoms and delayed hypercalcaemia. A 32-year-old female presents with headaches, vomiting and acute confusion. During admission she developed unresponsive episodes. She has a background of type 1 diabetes and hypothyroidism. A CT-head scan only showed lytic lesions. Lumbar puncture was sterile with high proteins. She was treated for meningoencephalitis. Further abdominal imaging showed splenomegaly with infiltrates. 8 weeks later she presented with severe hypercalcaemia, suggesting a potential underlying sarcoidosis. The CT-thorax scan done at the time showed mediastinal lymphadenopathy, but bronchoscopic biopsies were non-specific. A multidisciplinary team meeting concluded that the diagnosis was sarcoidosis with extrapulmonary manifestations based on the clinical picture. The diagnosis of neurosarcoidosis is dependent on clinical suspicion of the diagnosis followed by finding of granuloma in biopsy sample. The presence of both clinical symptoms and granuloma on biopsy confirms the diagnosis. This case report discusses neurological involvement and the non-specific presenting symptoms that make the diagnosis of neurosarcoidosis difficult.