Recurrence of sarcoidosis after lung transplantation presenting as neurosarcoidosis

Recurrence of pulmonary sarcoidosis after transplantation of the lung is known to occur and has not been shown to lead to negative outcomes. However, recurrence in a new primary organ is incredibly rare and not an established pattern of clinical presentation. Neurosarcoidosis can present in a variety of ways, one of which is development of acute encephalopathy and diffuse leptomeningeal enhancement on MRI imaging. In the case we present, the MRI findings, the improvement of symptoms and imaging abnormalities with steroid treatment support a diagnosis of probable neurosarcoidosis. Since a minority of patients who undergo lung transplantation have sarcoidosis, it is possible that subsequent development of neurosarcoidosis may be under recognized.