Page 84 - ECBIP 2021_Program

6th European Congress ECBIP 15 - 17
Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
PP58
MODERATED e-POSTER SESSION 09:
Miscellaneous and Rare Diseases
AN UNUSUAL PRESENTATION OF NEUROSARCOIDOSIS DIAGNOSED WITH EBUS-TBNA
Kar Mun Eu1, Chee Kiang Phua2, John Abisheganaden2
1 Woodlands Health Campus, Singapore, Singapore 2 Tan Tock Seng Hospital, Singapore, Singapore
Introduction: Sarcoidosis is a systemic disease of unclear etiology. Although it primarily affects the pulmonary system, neurosarcoidosis is a serious extra-pulmonary manifestation which occurs in 5-10% with myriad of clinical presentations, including headaches, seizures, ataxia, visual disturbances, loss of sensation, and other neurologic abnormalities. We describe an unusual case presenting with seizures.
Methods: A 31 year-old Malay male without significant past medical history presented following a motorcycle accident caused by first seizure. Cranial MRI imaging revealed clumped nodular extra-axial enhancement involving the Sylvian fissure. Investigations from lumbar puncture were unyielding.
Results: In view of the suspicion of neurosarcoidosis, CT thorax was performed despite a normal chest radiograph to explore alternative sites for histology which detected hilar and mediastinal lymphadenopathy. These were sampled via bronchoscopy with endobronchial ultrasound trans bronchial needle aspiration (EBUS-TBNA) using a 19G needle. Histology revealed non-necrotising granulomas but negative microbiology and flow cytometry for lymphoma. Airway inspection also revealed cobblestone mucosa (Figure 1) with lymphocytosis on bronchoalveolar lavage. Based on these findings, a diagnosis of probable neurosarcoidosis could be made in accordance to consensus criteria from the Neurosarcoidosis Consortium Consensus Group.
Conclusions: Atypical manifestations of sarcoidosis are diagnostically challenging. Neurosarcoidosis requires a high degree of suspicion, and pulmonary assessment can be useful in establishing diagnosis.
Clinical Implications: As isolated neurosarcoidosis is uncommon, pulmonary assessment for safer biopsy sites via bronchoscopy with EBUS TBNA should be considered even in the absence of respiratory symptoms and normal chest radiograph as sampling of neural tissue carries significant risk.
Figure 1: Cobblestone mucosa visualised on bronchoscopy
84 6th European Congress for Bronchology and Interventional Pulmonology