Hypertrophic cervical spine pachymeningitis due to sarcoidosis: a case report.

Publication/Presentation Date

4-2019

Abstract

Hypertrophic pachymeningitis (HP) is a chronic, progressive diffuse inflammatory condition that leads to thickening of the dura mater and can be idiopathic or associated with sarcoidosis among other disorders. In this case report, we present a rare case of cervical spine HP in a 29-year-old woman in the post-partum period, who had a history of pituitary adenoma and juvenile rheumatoid arthritis. Magnetic resonance imaging (MRI) of the spine revealed a soft tissue mass and moderate cord compression. The patient underwent C3-C7 laminectomy. Pathological analysis of the cervical epidural mass demonstrated a reactive inflammatory cell process. Recurrence of symptoms and worsening of pachymeningitis on imaging studies warranted further work-up which revealed mediastinal/hilar lymphadenopathy. Transbronchial biopsy revealed non-caseating granulomatous disease consistent with sarcoidosis. The patient was started on oral steroids and eventually methotrexate with significant clinical and radiographic improvement. Follow-up imaging studies showed minimal dural thickening in the thoracic spine and eventually complete resolution. HP should be considered in a patient with spinal cord compression, myelopathy, and radicular pain of unclear etiology, and sarcoidosis should be considered in idiopathic cases.

Volume

47

Issue

2

First Page

99

Last Page

103

ISSN

2154-8331

Disciplines

Medicine and Health Sciences | Neurology | Pathology | Surgery

PubMedID

30682899

Department(s)

Administration and Leadership, Department of Medicine, Department of Medicine Faculty, Department of Pathology and Laboratory Medicine, Pathology Laboratory Medicine Faculty, Department of Surgery, Department of Surgery Faculty

Document Type

Article

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