Isolated spinal neurosarcoidosis: an autopsy case

Study design: Autopsy cases of isolated spinal neurosarcoidosis are extremely rare or none. Objectives: To report an autopsy case of isolated spinal neurosarcoidosis without the involvement of other organs. Summary of Background data: A few reports of isolated spinal neurosarcoidosis are present, but no autopsy cases of isolated spinal neurosarcoidosis are present in the English literature. Setting: Japan. Methods: An autopsy case of isolated spinal neurosarcoidosis was examined pathologically. Results: A 54-year-old woman was admitted to our hospital because of leg numbness and muscle weakness. Imaging modalities showed an irregular contour and a mass-like lesion in the spinal cord. No biopsies were performed. Clinical diagnoses were suspected sarcoidosis and malignant lymphoma. The patient was treated by steroids and anti-cancer drugs, but she suddenly died of unknown cause. An autopsy revealed fibrosis and non-caseating granulomata in the spinal cord. No acid-fast bacteria or fungi were recognized by special stains. A PCR revealed no acid-fast bacteria including tuberculosis. Other organs including the brain and lung showed no sarcoidosis lesions. A pathological diagnosis of isolated spinal neurosarcoidosis was made. Other pathological diagnoses were systemic congestion, lung emphysema, food impaction in the upper esophagus and larynx, cardiac hypertrophy and marked dilation of the colon. The cause of death was thought to be respiratory failure. Conclusion: We have reported a very rare autopsy case of isolated spinal neurosarcoidosis, with an emphasis on pathological findings.