Disclosures: Eric P. Muneio, DO: No financial relationships or conflicts of interest

Case Description: We present a case of a female with known neurosarcoidosis who presented to the emergency department with acutely worsened left sided leg pain and weakness. A prior MRI had demonstrated neurosarcoidosis of the L5 nerve root and the patient was currently on high dose prednisone as treatment. The patient was continued on high dose steroids and started on gabapentin. A repeat MRI was ordered to evaluate for worsening neurosarcoidosis and any other pathology. MRI findings demonstrated a large disc herniation at L4-5 causing marked foraminal stenosis at the left L4 lateral recess. These findings, along with prior MRI findings of neurosarcoidosis of the left L5 nerve root complicated the diagnosis for this patient’s pain. The patient was offered a left L4 transforaminal epidural steroid injection for treatment of the acute pain.

Setting: Community acute rehabilitation hospital.

Patient: 51 year old female with sarcoidosis and neurosarcoidosis. Assessment/

Results: The patient’s symptoms rapidly improved and no interventional procedure was required. She was transferred to acute rehabilitation where she continued to make improvements in her mobility prior to being discharged home with home therapy.

Discussion: Neurosarcoidosis is an uncommon variant of sarcoidosis that can have varying presentations. Symptoms of neurosarcoidosis can often mimic other disease process. Our patient’s acute pain and subjective weakness could be explained by both the active L5 nerve root neurosarcoidosis and the acute disc herniation.

Conclusion: Our case not only demonstrates an uncommon presentation of neurosarcoidoss, but also the challenge of determining the source of pain in a patient with two active disease process. We also present a novel therapy for neurosarcoidosis affecting lumbar nerve roots.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-radicular-leg-pain-in-a-patient-with-known-neurosarcoidosis-a-case-report/