Sarcoidosis may involve both the central and peripheral nervous system, although peripheral nerve manifestations are usually seen late in the disease. In this report, the authors describe a case of
sarcoidosis in a 22-year-old woman who presented with a
foot drop. Although results of conventional lumbar magnetic resonance (MR) imaging were normal, MR peripheral nerve imaging of the thigh showed a mass in the sciatic nerve indicating
tumor. An intraoperative biopsy sample revealed noncaseating
granulomas consistent with sarcoid. The patient was treated with
steroid drugs to control the manifestations of
her disease but exhibited early signs of femoral
bone necrosis, which required discontinuation of the
steroids. She was then treated with local
radiation therapy. At her 2-year follow-up visit the patient demonstrated relief of her symptoms and improvement on MR peripheral nerve imaging. This case demonstrates that
sarcoidosis may present with peripheral nerve manifestations. The appearance of a diffusely swollen nerve on MR imaging should prompt clinicians to include
sarcoidosis in the differential diagnosis and plan surgery accordingly. Patients who are not responsive to or who are unable to tolerate medical
therapy may be treated with
radiation therapy.