Resolution of Possible Neurosarcoidosis With Early Initiation of Glucocorticoids in the Acute Inpatient Setting: A Case Report

Neurosarcoidosis is an autoimmune disorder of unknown etiology. We report a case of a 27-year-old African American male presenting with fever, vomiting, and seizure. Initially, bacterial meningitis was suspected, and empiric antibiotics with dexamethasone were started. Workup revealed negative cultures, leptomeningeal enhancement, and cavitary lung nodules with hilar lymphadenopathy on imaging and elevated angiotensin-converting enzyme levels on cerebrospinal fluid (CSF) analysis. Neurosarcoidosis was then suspected, and a lung biopsy was performed. The results were inconclusive, but the patient’s condition improved. He was discharged on prednisone. Our case demonstrates the diagnostic difficulty of neurosarcoidosis while displaying the importance of early initiation of glucocorticoids in the acute inpatient setting.