Résumé :
|
INTRODUCTION : Neurological involevement during sarcoidosis are rare and varied. We report a case of a patient who presented a cranial pachymeningitis and the occurrence of local symptomatic muscular affection that allowed sarcoidosis' diagnosis. CASE REPORT : 42 years old women. presented 2 months before her admission severe headache worsened by bilaterally visual acuity decline. The neurological and physical examination were unremarkable except bilateral blindness. Brain MRI revealed diffuse pachymeningitis with meningeal intense contrast enhancement. An etiological assessment was performed with a normal LCR, increased SR up to 65, a microcytic hypochromic anemia with a slight lymphopenia in T-cell count, a polyclonal hypergammaglobulinemia, the tuberculin test was negative, the chest scan showed mediastinal lymphadenopathy. The Bronchoscopy with biopsies didn't show specific inflammatory changes. The calcium and phosphate and the converting angiotensin enzyme were normal. The Meningeal biopsy revealed non-necrotizing epithelioid granulomas. The patient received a bolus of corticosteroids without improvement of her visual acuity. Two months later, The evolution was underlined by the onset of severe myalgia of the 2 calves. The calves were swollen, hot, with very painful palpable nodules .CPK and LDH were normal. The EMG was myogenic and the ultrasound showed several well-circumscribed hypoechgenic Formation. The echo-guided muscle biopsy showed the presence of non necrosis epitheloid granuloma. The patient received a bolus of steroids with a speedy improvement of the muscle's affection withing 3 days relayed oral corticosteroids. DISCUSSION: Our patient presented meningeal affection, and a muscle involevement whose histopathological study led to sarcoidosis diagnosis. Particular aspect in our report is the fact that the symptomatic muscular affection in sarcoidosis remains exceptional. Tuberculosis is a main differential diagnosis especially in our endemic context. CONCLUSION: Our report Underlying the importance of thinking about sarcoidosis as possible diagnosis eventhough in front of the presence of less frequent clinical involevement as the symptomatic muscle affection.
|