Disclosures: Samantha Mastanduno, DO: Nothing to disclose

Case Description: Patient with history of HIV, who presented with two weeks of progressive right lower extremity sensory loss and left hemiparesis. Exam was consistent with Brown-Sequard Syndrome (BSS) with left upper and lower extremity weakness, impaired pinprick sensation throughout right lower extremity, and decreased temperature sensation throughout right upper and lower extremity.

Setting: Hospital Inpatient Unit

Patient: 50-year-old male with Brown-Sequard Syndrome (BSS).

Assessment/Results: MRI cervical spine revealed focal nodular enhancement at the left C5-C6 spinal cord with associated extensive cord signal changes and expansion from C2-T1. Labs were notable for elevated inflammatory markers, elevated angiotensin-converting enzyme (ACE) and CSF protein. Chest CT was significant for mediastinal and left perihilar lymphadenopathy. Bronchoscopy revealed endobronchial studding and non-caseating granulomas most consistent with sarcoidosis. He was started on methylprednisolone for spinal neurosarcoidosis with improvement in strength.

Discussion: Sarcoidosis is a multiorgan system disease characterized by noncaseating granulomas. Sarcoidosis involving the spinal cord (spinal neurosarcoidosis) is rare. Moreover, the diagnosis of spinal neurosarcoidosis is challenging due to its significant variability in clinical findings and lack of definitive laboratory or imaging characteristics. In patients with HIV the diagnosis might be even more difficult since there are numerous HIV-associated pathogenic processes that can lead to spinal cord dysfunction. Research on the coexistence of HIV and sarcoidosis has also shown that sarcoidosis can develop during the restoration of T-cell immunity associated with antiretroviral therapy (Immune Reconstitution Inflammatory Syndrome). This phenomenon as well as the diagnostic challenges highlights the importance of considering neurosarcoidosis in the differential of patients with myelopathy, especially patients with HIV.

Conclusion: We report an unusual case of neurosarcoidosis presenting as BSS in a patient with HIV. Although neurosarcoidosis is rare, this case underscores the importance of considering this diagnosis in patients presenting with myelopathy and its significance in patients with concurrent HIV.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cervical-brown-sequard-syndrome-due-to-neurosarcoidosis-in-a-patient-with-hiv-a-case-report/