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Letter to the Editor
Usefulness of 18F-FDG-PET/CT imaging in a patient with neurosarcoidosis
Utilidad de la 18F-FDG-PET/CT en un paciente con neurosarcoidosis
Julio F. Jiménez-Bonillaa,
Corresponding author
jjimenez@humv.es

Corresponding author.
, Miguel A. González-Gayb,c,d, Ignacio Banzoa
a Nuclear Medicine Department, University Hospital Marqués de Valdecilla, University of Cantabria, Molecular Imaging Group – IDIVAL, Santander, Spain
b Department of Rheumatology, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain
c School of Medicine, University of Cantabria, Santander, Spain
d Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Neurosarcoidosis is a rare neuro-inflammatory disorder with protean manifestations which represents a diagnostic challenge&#46; It can show different clinical presentation&#44; from chronic meningitis to myelopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Their identification in a patient is critical for applying an appropriate treatment in order to decrease the mortality and morbidity and to obtain lower relapse rates&#46; Gadolinium-enhanced MRI is the preferred imaging modality for neurosarcoidosis</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 30-year-old woman with an unremarkable past history presented to the hospital with a history of conjunctival hyperemia&#44; photosensitivity and pain in the right eye of four weeks duration&#46; She also complained of pain of both ankles&#44; knees and lumbo-sacral region&#46; She also noticed painful pretibial nodular lesions&#46; A sarcoidosis was suspected&#46; However&#44; a chest radiograph did not show abnormalities&#46; Symptoms worsened over the last two weeks prior to admission since she started to have vertigo and paresthesias in the tongue and in the left side of her face&#46; On admission the physical examination disclosed a left-sided peripheral facial nerve palsy&#46; Spinal and brain MRI were reported as being normal&#46; A treatment with 30<span class="elsevierStyleHsp" style=""></span>mg&#47;day of prednisone was started&#46; However&#44; symptoms did not improve&#46; In addition&#44; and a bilateral uveitis with vitritis was also observed&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">An <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT disclosed abnormal hypermetabolic uptake in the hilar and mediastinal lymph nodes&#44; in both parotid glands and a diffuse uptake throughout the spinal cord&#44; more intense at the upper and lower ends &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Taking into account the clinical data along with the <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT findings a diagnosis of neurosarcoidosis was considered&#46; Further studies included a lumbar puncture that showed abnormal cerebrospinal fluid consisting of raised protein level and lymphocytic pleocytosis and an increased CD4&#47;CD8 ratio&#46; A parotid gland biopsy confirmed the presence of non-caseating sarcoid granulomas&#46; A treatment consisting of intravenous methyl-prednisolone pulses &#40;500<span class="elsevierStyleHsp" style=""></span>mg&#47;day for three consecutive days&#41; followed by oral prednisone 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 3 weeks and then progressive tapering of the prednisone dose&#44; methotrexate &#40;10<span class="elsevierStyleHsp" style=""></span>mg&#47;week&#47;subcutaneously&#41;&#44; and intravenous anti-TNF-infliximab &#40;5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg at day 0&#44; at week 2&#44; week 6 and then every 8 weeks&#41; was started&#46; Following this treatment&#44; the patients experienced a progressive improvement of symptoms&#46; At present&#44; 6 months after the diagnosis of sarcoidosis the patient is asymptomatic&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The present case is of interest because spinal and brain MRI were normal&#46; However&#44; an <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT assessed the extent of the disease affecting the spinal cord&#46; The diagnosis was confirmed by cerebrospinal fluid analysis&#46; MRI and PET imaging discordance in neurosarcoidosis has been previously reported in some isolated reports&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Nevertheless&#44; this relevant finding reinforces the useful role of <span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT in difficult cases&#44; because it is able to show the metabolic abnormalities linked to neuroinflammation&#44; specially in the absence of infiltrative spinal cord lesions&#44; which are more suitable to be detected by MRI&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">18</span>F-FDG PET&#47;CT offers an early metabolic window to investigate a potential neurosarcoidosis&#46;</p></span>"
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Original language: English
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