Hearing Loss with Diffuse Meningeal Enhancement: A Rare Initial Presentation of Sarcoidosis

Background: Sarcoidosis is a systemic disease that can affect almost any organ system, with lungs being the most commonly involved. Other organ systems that may be affected include the skin, eyes, joints, heart, kidneys, or the gastrointestinal tract. Symptoms of sarcoidosis depend on the organ system involved. For instance, pulmonary involvement usually presents with cough and shortness of breath. Involvement of the joint usually presents with joint pain. Neurological manifestation, termed as neurosarcoidosis, is a relatively uncommon initial presentation of sarcoidosis. Patients with neurosarcoidosis can be asymptomatic or have multiple neurological findings such as numbness, paresthesias, hearing loss, vision changes, headaches etc. Case Report: We report a case of a young African American male who presented with hearing loss and bilateral lower extremity paresthesias. Subsequent imaging of his brain and spinal cord showed diffuse meningeal enhancement of the cerebrum, thoracolumbar spine, and cranial nerves (CN) V, VII, and VIII. Biopsy of calcified subcarinal lymph nodes seen on imaging showed non-caseating granulomas, consistent with the diagnosis of sarcoidosis. Conclusion: Neurosarcoidosis can present in many different ways, making it difficult to diagnose. There have been multiple studies that tried to find a pattern to this disease in order to make the diagnosis easier. However, no specific or sensitive findings to neurosarcoidosis could be concluded from those studies. To our knowledge, such a diffuse involvement of sarcoidosis in the nervous system has so far not been reported. Our case demonstrates yet another way neurosarcoidosis can present and the importance of keeping this diagnosis on the differential when dealing with patients presenting with similar symptoms.