脊髄サルコイドーシス

Spinal Cord Sarcoidosis

脊髄サルコイドーシスは，脊髄病変の生検が困難な場合が多く，確定診断を得難い。組織診断以外に特異的な検査所見はなく，臨床症状，細かな全身検索，脊髄以外の可能な部位での生検といった多くの所見を総合して診断精度を高めることを心がけたい。長期間の免疫治療を要する例が多く，診断根拠が乏しい段階での治療開始は極力避け，治療による修飾を受ける前に過不足なく検査を行い，より多くの診断根拠を得る努力が必要である。

Abstract

Spinal cord sarcoidosis is rare, but often appears as a diagnostic challenge in myelopathy of unknown origin. Although definite diagnosis requires histological confirmation of non-caseating epithelioid granuloma in the spinal cord, it is hardly obtained due to the invasiveness of the biopsy procedure. Hence, extensive searches for involvement of other organs involvement should be prompted, including biopsy of the most “promising” and “easy touch” lesions identified in individual patients. Spinal sarcoidosis is generally treated with high-dose corticosteroids, immunosuppressants, or both, but it is often refractory to treatment and requires a long treatment period. Therefore, extensive examinations to evaluate the likelihood of sarcoidosis should be carried out before the initiation of immunotherapy, especially in cases without histological confirmation.