Case Report:Sarcoidosis with Peripheral neuropathy

Abstract Background: Peripheral neuropathy is a broad term that encompasses various disorders of the peripheral nervous system. This includes granulomatous neuropathy and non- granulomatous small fiber neuropathy (SFN). The most prevalent clinical manifestations of granulomatous neuropathy are distal symmetric polyneuropathy and asymmetric polyradiculoneuropathy. Common causes of peripheral neuropathy include glycometabolic disturbance, infection, inflammation, and intoxication. However, cases of sarcoidosis are rare. Case Presentation: A 58-year-old female driving instructor with no previous medical history presented to the hospital with initial numbness in her left foot, followed by numbness and weakness in her right foot and both feet. A month later, she experienced bilateral numbness below the wrist. The patient underwent a lumbar puncture and further testing for auto-antibodies in both the cerebrospinal fluid (CSF) and serum. The results showed negative findings for seventeen antibodies related to peripheral neuropathy and Anti-MAG antibody. Enhanced chest CT revealed multiple swollen lymph nodes in the neck, mediastinum, and bilateral hilar area. Ultrasonography also confirmed enlarged lymph nodes in the bilateral supraclavicular, subclavian region, and mediastinum. Electromyography (EMG) and Nerve conduction studies (NCS) indicated asymmetric motor and sensory polyneuropathy. Additionally, the histological examination of a supraclavicular lymph node revealed characteristic non-caseating granulomas (NCG). Conclusion: This case report highlights the potential of peripheral neuropathy as a clinical manifestation of sarcoidosis. It emphasizes the importance of considering sarcoidosis as a possible diagnosis in patients presenting with peripheral neuropathy, thereby contributing to increased knowledge and reducing the risk of misdiagnosis.