Abstract：
Sarcoidosis, a systemic granulomatous disease primarily affecting the respiratory and lymphatic systems, can rarely manifest as neurosarcoidosis either in isolation or alongside other systemic symptoms. Here, we describe the case of a 45-year-old male with a history of recurrent sinusitis refractory to antibiotics, who presented to the emergency department with sinus congestion and dysphagia. Clinical examination revealed left lower motor neuron facial palsy and enlarged submandibular salivary glands. Despite obtaining negative results from various antibody panels, the patient exhibited elevated Angiotensin Converting Enzyme levels of 83 nmol/kg/min. Additionally, computed tomography chest scans revealed bilateral hilar and mediastinal lymph node enlargement, findings consistent with sarcoidosis. Otorhinolaryngology evaluation for dysphagia confirmed left vocal cord palsy. Following a negative infectious disease workup, submandibular salivary gland biopsy confirmed sarcoidosis. Treatment with mycophenolate mofetil and oral steroids led to gradual improvement in salivary gland swelling, dysphagia, and facial palsy. However, worsening left shoulder pain prompted further investigation, revealing winging of the left scapula on repeat examination. Magnetic resonance imaging (MRI) of the cervical spine revealed a six mm hyperintensity in the left dorsal cord at the C5 level, suggesting possible neurosarcoidosis vs. demyelinating disease. Subsequently, the patient was prescribed anti-tumor necrosis factor alpha inhibitor infliximab. Subsequent MRI of the cervical spine, conducted six months after initiating Infliximab therapy, indicated resolution of the lesions. This positive outcome was supported by the patient\'s report of symptom improvement, notably reduced shoulder pain and improvement in left scapular winging. This case underscores the unusual co-occurrence of Bell\'s palsy and vocal cord palsy in the same patient, along with the potential contribution of neurosarcoidosis to the winged scapula. Additionally, it sheds light on the positive response of neurosarcoidosis to Infliximab therapy.
摘要：
结节病,主要影响呼吸和淋巴系统的全身性肉芽肿疾病，孤立或伴随其他全身症状很少表现为神经结节病。这里,我们描述了一名45岁的男性，有抗生素难治性复发性鼻窦炎的病史，他出现了鼻窦充血和吞咽困难。临床检查发现左下运动神经元面神经麻痹和下颌下涎腺扩大。尽管从各种抗体组中获得阴性结果，患者表现出83nmol/kg/min的血管紧张素转换酶水平升高。此外,计算机断层扫描胸部扫描显示双侧肺门和纵隔淋巴结肿大，结果与结节病一致。吞咽困难的耳鼻咽喉科评估证实左声带麻痹。经过阴性传染病检查，颌下腺活检证实结节病。霉酚酸酯和口服类固醇治疗导致唾液腺肿胀逐渐改善，吞咽困难,和面神经麻痹.然而,左肩疼痛恶化促使进一步调查，重复检查时左肩胛骨的翅膀露出。颈椎的磁共振成像（MRI）显示C5水平的左背侧脊髓有6毫米的高强度，提示可能的神经结节病与脱髓鞘病.随后，患者接受抗肿瘤坏死因子α抑制剂英夫利昔单抗治疗.随后的颈椎MRI，在开始英夫利昔单抗治疗后六个月进行，指示病灶消退。这种积极的结果得到了患者的症状改善报告的支持，肩部疼痛明显减轻，左肩胛骨改善。该病例强调了贝尔麻痹和声带麻痹在同一患者中的异常并存。以及神经结节病对有翼肩胛骨的潜在贡献。此外,它揭示了神经结节病对英夫利昔单抗治疗的积极反应。
