Mononeuritis multiplex secondary to sarcoidosis

Peripheral nerve involvement is a rare, yet treatable neurological manifestation of sarcoidosis. Most patients respond well to corticosteroids, but relapses are common and the long-term prognosis remains unpredictable. We present a patient with an asymmetrical neurological presentation of previously undiagnosed sarcoidosis. She presented with paresthesias and predominantly distal extremity weakness. Other possible causes of neuropathy were ruled out and she was found to have an elevated serum ACE level. A nerve/lip biopsy demonstrated non-caseating granulomas consistent with sarcoid. Her clinical outcome was favorable after initiating treatment with high dose oral prednisone.