硬膜に発生したSarcoidosisの1例

A Case of Dural Sarcoidosis

I．はじめに

　Sarcoidosisは全身病であり，頭蓋内に病変を伴うことは比較的少なく，その発現率は4-5％とされている^4）．なかでも硬膜にsarcoidosisが発生することは稀であり，過去に8例が報告されているに過ぎない^{1,2,6,9,11,13，14,16）}われわれは硬膜に発生したsarcoidosisの1症例を経験したので文献的考察を加え報告する．

A 26 year-old man, who was treated for meningitis in our hospital previously, was rehospitalized 1 year later because he developed disturbance of consciousness, gait disturbance and urinary incontinence. Blood examina-tion revealed accelerated ESR, elevated GPT, slight elevation of serum Ca, strong positive CRP, and a de-crease in PHA and Con A. ACE was within normal range and tuberculin reaction was negative. Lumbar puncture revealed that the initial pressure was 310mmH20, cells were 152/3, and protein was 343mg/ dl. Bilateral hilar lymphadenopathy was absent in chest X ray film. Head CT revealed enlarged lateral ventri-cles and irregularly enhancing nodular lesions in the anterior half of the falx cerebri, and abnormally strong enhancement of the choroid plexus. Ventriculoperi-toneal shunt was perfomed. As a diagnosis was difficult to obtain from the clinial data, biopsy of the nodular le-sions was performed. The histopathologic diagnosis was sarcoidosis. Steroid hormone was administerd thereafter, and the nodular lesions of the falx dis-appeared in the follow-up.

In the literature, only 8 cases of sarcoidosis of the dura mater have been reported. Since intracranial sarcoidosis is a part of systemic sarcoidosis, its diagnosis is not difficult in most cases. However, in cases difficult to diagnose as in our case, biopsy may be necessary. When nodular lesion occurs in the dura mater, sarcoidosis must be included as a possibility in the differential diagnosis in addition to the usual meningioma, lymphoma, and metastatic brain tumor.