Abstract Details

Title Spinal Arachnoiditis as a Manifestation of Sarcoidosis

Topic Neurotoxicology

Presentation(s) P06 - (-)

Poster/Presentation
Number 229

Objective

Background BACKGROUND: Spinal arachnoiditis is caused by inflammation of the spinal cord arachnoid membrane. Typical symptoms include back pain, urinary urgency and/or incontinence, sensory loss and weakness in the lower extremities. Identified causes include infection, spinal surgery, epidural anesthesia or steroid injection and myelographic contrast materials. We report a rare case of spinal arachnoiditis as a manifestation of sarcoidosis.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: A 49 year-old man with a history of "asthma" presented with chronic low back pain and urinary urgency. Exam revealed moderate weakness in bilateral foot dorsiflexion and toe extension as well as atrophy of intrinsic foot muscles. Deep tendon reflexes were reduced in the legs. MRI of the lumbar spine demonstrated thickening and clumping of nerve roots which adhered to the walls of the thecal sac. A diagnosis of spinal arachnoiditis was made. No risk factors for this condition were identified in the patient. A work up for infectious, metabolic and autoimmune etiology was negative. A spinal tap revealed slightly elevated white cell of 7 per [micro]L (normal: 0-5) and CSF protein of 54 mg per dL (normal: 15-45). A CT chest showed aortopulmonary and hilar lymph nodes with severe consolidations and ground glass appearance in both lobes. Transbronchial biopsy revealed the presence of noncaseating granuloma with negative stains and cultures for acid fast bacilli and fungi. The patient was diagnosed with sarcoidosis. His pulmonary symptoms and CT chest appearance improved after treatment with oral corticosteroid but he continued to require pain medication for back pain.

Conclusions CONCLUSIONS: Spinal sarcoid is very rare, and most cases present as intramedullary lesions. This case underscores the importance of including sarcoidosis in the differential diagnosis of spinal arachnoiditis when no clear risk factor for it can be identified.

Authors/Disclosures
Qin Li Jiang, MD (Jesse Brown VA Medical Center) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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