Abstract Details

Title Granulomatous Disease Misdiagnosis: A Case Report

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 088

Objective To present a case report of a patient originally diagnosed with neurosarcoidosis, but ultimately found to have Blastomycosis causing significant delays in treatment and overall worsened prognosis.

Background Blastomycosis, a fungal infection caused by Blastomyces dermatitidis, has CNS involvement in approximately 1% of cases. It can be considered a mimicker of sarcoidosis due to its frequent pulmonary and neurologic involvement as well as granulomatous appearance on pathology.

Design/Methods N/A

Results A 34-year-old female was transferred for management of headaches. Recent lung mass biopsy at outside center resulted in a reported diagnosis of pulmonary sarcoidosis, prompting treatment with prednisone and improvement in shortness of breath. New-onset headaches 3 months later prompted CSF analysis which showed pleocytosis (slight neutrophilic predominance), elevated protein, decreased glucose, and elevated ACE. Imaging showed hydrocephalus and spinal meningeal enhancement. She improved with pulse dose steroids and eventually required EVD placement. For probable neurosarcoidosis, infliximab therapy had been planned, but fevers and quadriparesis four months later prompted repeat imaging which showed a large extramedullary cervical spine mass. Biopsy of the mass was consistent with blastomycosis. A previous bronchoalveolar lavage from outside hospital the year prior had revealed blastomycosis, and treatment course was felt to have been non-therapeutic due to concurrent steroids for presumed sarcoidosis given multiple non-necrotizing granulomas on initial lung biopsy. She was subsequently weaned off steroids and started on antifungal therapy.

Conclusions Fungal infections can mimic sarcoidosis. Fungi such as blastomycosis may result in non-necrotizing granulomatous inflammation on pathology review. Biopsy specimens and patients with suspected sarcoidosis should be evaluated for fungal disease as prompt initiation of correct treatment is vital to reducing likelihood of neurologic disability. A high degree of suspicion should be had if symptomatology progresses despite therapy, and consideration of neurosarcoidosis should prompt collaboration with experts.

Authors/Disclosures
Stefanie J. Rodenbeck, MD (Indiana University) PRESENTER	Dr. Rodenbeck has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Rodenbeck has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Rodenbeck has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen.
Madison Ott, MD (IU Health)	Dr. Ott has nothing to disclose.

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