Sarcoidosis is a multisystem granulomatous disease of unknown etiology that most commonly affects the lungs and lymphatic system, while central nervous system involvement is rare and diagnostically challenging. We report a case of multisystem sarcoidosis presenting with facial nerve palsy and a solitary enhancing brain lesion. A 41-year-old woman presented with right-sided facial paralysis. Contrast-enhanced brain MRI revealed right lateral ventricular enlargement with irregular walls, pituitary gland thickening and enhancement, a 6 mm enhancing nodular lesion in the left parietal lobe, and bilateral lacrimal gland enlargement. Axillary lymph node biopsy demonstrated granulomatous inflammation. Thoracic CT showed lymphadenopathy, perilymphatic nodules, and lytic rib lesions indicating osseous involvement. Elevated ACE levels supported the diagnosis. Based on clinical, radiological, and histopathological findings, multisystem sarcoidosis with neurosarcoidosis was diagnosed. This case highlights the importance of considering sarcoidosis in patients with solitary brain lesions and cranial neuropathies, especially in the presence of systemic involvement.
Bilgin et al. (Thu,) studied this question.