Bipolar affective disorder in a patient with neurosarcoidosis – A case report

Abstract

Background: Sarcoidosis is a rare clinical condition that can involve the central nervous system. 20% of cases of neurosarcoidosis (NS) can have psychiatric manifestations. Here, we highlight a case of bipolar affective disorder (BPAD) for 25 years with NS. Case report: A 50-year-old woman presented with progressive sensorineural hearing loss from 15 years of age and BPAD for 25 years. She developed generalized tonic clonic seizure and catatonia while on sodium valproate, leading to a detailed medical evaluation. Neuroimaging showed leptomeningeal enhancements, atherosclerosis, and stenosis of the internal carotid artery. Her serum angiotensin-converting enzyme level was elevated, and chest X-ray showed parenchymal lesions. She was diagnosed with neurosarcoidosis. Her condition improved with steroids and mycophenolate mofetil. BPAD was treated with sodium valproate. Discussion: Rare medical conditions like NS can present as psychiatric disorders. Poor response and vulnerability to adverse effects of psychotropics warrant a detailed clinical evaluation for organic etiology.