{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T23:16:58Z","timestamp":1740179818830,"version":"3.37.3"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:00:00Z","timestamp":1716422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>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\u2009nmol\/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 6-mm hyperintensity in the left dorsal cord at the C5 level, suggesting possible neurosarcoidosis vs. demyelinating disease. Subsequently, the patient was prescribed anti-tumour necrosis factor alpha inhibitor infliximab. Subsequent MRI of the cervical spine, conducted 6\u2009months after initiating infliximab therapy, indicated resolution of the lesions. This positive outcome was supported by the patient\u2019s report of symptom improvement, notably reduced shoulder pain and improvement in left scapular winging. This case underscores the unusual co-occurrence of Bell\u2019s 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.<\/jats:p>","DOI":"10.1093\/mrcr\/rxae030","type":"journal-article","created":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T21:17:37Z","timestamp":1716412657000},"page":"184-187","source":"Crossref","is-referenced-by-count":0,"title":["Neurosarcoidosis-induced winging scapula: Efficacy of infliximab treatment in addressing multifaceted challenges"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0604-0501","authenticated-orcid":false,"given":"Richa","family":"Purohit","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Concentra Medical Center , Orlando, FL,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi Shahu","family":"Khal","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University of Central Florida HCA Healthcare GME , Orlando, FL,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"McCabe","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University of Central Florida HCA Healthcare GME , Orlando, FL,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neha","family":"Bhanusali","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University of Central Florida College of Medicine , Orlando, FL,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Farooq","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University of Central Florida College of Medicine , Orlando, FL,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shazia","family":"Beg","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, University of Central Florida College of Medicine , Orlando, FL,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,5,23]]},"reference":[{"key":"2025011615465122200_R1","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1056\/NEJM199704243361706","article-title":"Sarcoidosis","volume":"336","author":"Newman","year":"1997","journal-title":"N Engl J Med"},{"key":"2025011615465122200_R2","doi-asserted-by":"crossref","first-page":"429","DOI":"10.2174\/157015911796557975","article-title":"Neurosarcoidosis","volume":"9","author":"Lacomis","year":"2011","journal-title":"Curr Neuropharmacol"},{"key":"2025011615465122200_R3","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1093\/qjmed\/92.2.103","article-title":"Central nervous system sarcoidosis\u2014diagnosis and management","volume":"92","author":"Zajicek","year":"1999","journal-title":"QJM"},{"key":"2025011615465122200_R4","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/j.1600-0404.1986.tb03277.x","article-title":"Neurosarcoidosis: clinical presentations and course in 50 patients","volume":"73","author":"Oksanen","year":"1986","journal-title":"Acta Neurol Scand"},{"key":"2025011615465122200_R5","article-title":"Sarcoidosis presenting as vocal cord palsy: an unusual presentation and literature review","volume":"9","author":"Raja","year":"2020","journal-title":"Respirol Case Rep"},{"key":"2025011615465122200_R6","doi-asserted-by":"crossref","DOI":"10.1378\/chest.128.4_MeetingAbstracts.465S","article-title":"Persistent hoarseness of voice in a sarcoid patient: a clue to laryngeal sarcoidosis; a potential cause of upper airway obstruction","volume":"128","author":"Rupanagudi","year":"2005","journal-title":"Chest"},{"key":"2025011615465122200_R7","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2015-209728","article-title":"A rare manifestation of a multisystemic disease: a case of vocal cord palsy secondary to sarcoidosis","author":"Mastan","year":"2015","journal-title":"BMJ Case Rep"},{"key":"2025011615465122200_R8","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.7326\/0003-4819-119-12-199312150-00007","article-title":"Glucocorticoid therapy for immune-mediated diseases: basic and clinical correlates","volume":"119","author":"Boumpas","year":"1993","journal-title":"Ann Intern Med"},{"key":"2025011615465122200_R9","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1001\/archneur.1995.00540330053014","article-title":"Therapeutic considerations in patients with refractory neurosarcoidosis","volume":"52","author":"Agbogu","year":"1995","journal-title":"Arch Neurol"},{"key":"2025011615465122200_R10","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1212\/WNL.0000000000004644","article-title":"Infliximab for the treatment of CNS sarcoidosis: a multi-institutional series","volume":"89","author":"Gelfand","year":"2017","journal-title":"Neurology"}],"container-title":["Modern Rheumatology Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mrcr\/advance-article-pdf\/doi\/10.1093\/mrcr\/rxae030\/58183616\/rxae030.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/9\/1\/184\/58183616\/rxae030.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/9\/1\/184\/58183616\/rxae030.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T15:53:29Z","timestamp":1737042809000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mrcr\/article\/9\/1\/184\/7680337"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,23]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,5,23]]},"published-print":{"date-parts":[[2025,1,16]]}},"URL":"https:\/\/doi.org\/10.1093\/mrcr\/rxae030","relation":{},"ISSN":["2472-5625"],"issn-type":[{"type":"electronic","value":"2472-5625"}],"subject":[],"published-other":{"date-parts":[[2025,1]]},"published":{"date-parts":[[2024,5,23]]}}}