A Rare Presentation of Intramedullary Spinal Neurosarcoidosis without Systemic Manifestations: A Case Report and Literature Review

Background Sarcoidosis is a systemic inflammatory disease of uncertain etiology characterized by the formation of noncaseating granulomas affecting multiple organ systems. While pulmonary and lymphatic involvement commonly occur and aid in diagnosis, central nervous system (CNS) involvement is rare, occurring in only 3–10% of cases. Intramedullary spinal neurosarcoidosis (NS) is extremely rare, accounting for less than 1% of all cases, and presents substantial diagnostic challenges due to its nonspecific clinical and radiological features, which can mimic a range of other spinal cord disorders. Unlike systemic sarcoidosis, NS may manifest mainly as a neurological condition without systemic symptoms, complicating its identification and management. Case Presentation: A 35-year-old male presented with progressive lower limb weakness and neuropathic pain. Initial imaging suggested a diagnosis of transverse myelitis, but further investigation and evaluation revealed an intramedullary lesion at the T6–T8 level. Surgical removal of the lesion was performed, and a biopsy was performed, confirming the diagnosis of intramedullary spinal NS. The patient subsequently started receiving corticosteroid therapy and long-term immunosuppression, which resulted in partial recovery. Conclusion This case demonstrates the challenges in detecting patients with intramedullary spinal NS, particularly in the absence of systemic symptoms. Advanced imaging, histopathological evaluation, and a multidisciplinary approach are essential for precise diagnosis and effective treatment. These findings emphasize the need for personalized therapeutic strategies when addressing such uncommon presentations and challenges, contributing to the expanding body of literature on intramedullary spinal NS.