Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A patient with sarcoidosis needed differential diagnosis from motor neuron disease

Takashi Koide, M.D.1), Masato Kanazawa, M.D.1), Junsuke Shinbo, M.D.1), Katsuhiro Urayama, M.D.2), Nobuo Yagi, M.D.3), Shoichi Tsuchida, M.D.3), Ken Saito, M.D.4) and Hideaki Ishiguro, M.D.1)

Departments of 1)Neurology, 2)Otolaryngology, 3)Thoracic Surgery and 4)Pathology, Akita Red Cross Hospital

A 50-year-old woman lost about 10 kg of body weight within two months. Thereafter, she developed dysphagia and dysphonia. She visited our hospital and presented with a weak elevation of the soft palate, fasciculation of the tongue, hoarseness of voice, muscle weakness of the neck and extremities, and a decrement in vital capacity. She was admitted with a provisional diagnosis of motor neuron disease. The results of laboratory examinations showed an elevation in serum lysozyme and liquor protein levels, and pleocytosis in the liquor. Needle electromyography showed neurogenic changes, and bilateral hilar lymphadenopathy was revealed by computerized tomography. A biopsy specimen was excised from lymph nodes near the right anterior scalene muscle, which showed noncaseating granulomas consistent with sarcoidosis. All her symptoms improved after steroid administration. Such patients can be treatable with steroids. Moreover, the differential diagnosis from motor neuron disease is important.

(CLINICA NEUROL, 45: 485|489, 2005)
key words: sarcoidosis, motor neuron disease, scalene muscle biopsy, steroid

(Received: 27-Dec-03)