Electrodiagnostic / Neuromuscular Medicine
Esha Jain, MD
Medical Resident
Medstar Georgetown National Rehabilitation Hospital
Washington, District of Columbia, United States
Danielle Cherrick, MD
Attending Physician
OrthoVirginia
McLean, Virginia, United States
Esha Jain, MD
esha.jain@hotmail.com
Washington, District of Columbia, United States
This case describes a patient with pulmonary sarcoidosis and chronic cervical radiculopathy who was diagnosed with concomitant brachial plexopathy.
Case Description:
A 45-year-old male with history of pulmonary sarcoidosis and chronic right C4-C5 radiculopathy presented with right upper extremity shoulder pain, progressive biceps weakness graded 3/5, and diminished sensation. His last episode of severe cervical radiculopathy occurred in 2023 without neurologic deficit, and he had responded well to a single epidural steroid injection.
A cervical spine MRI from three months prior demonstrated mild central disc protrusion at C4-5, and C5-6 annular disc bulge along with bilateral neural foraminal narrowing, initially suggesting recurrent radiculopathy. However, the severity of his new neurological deficits appeared disproportionate to the MRI findings. Given his history of sarcoidosis, brachial plexopathy was placed higher on the differential diagnosis, prompting further evaluation.
EMG/NCS revealed denervation changes localizing to the upper brachial plexus with possible C6 root involvement. A brachial plexus MRI demonstrated thickening and hyperintensity of the C5 nerve root extending into the upper trunk, consistent with brachial plexopathy.
Discussions:
This case illustrates the importance of considering neurosarcoidosis in patients with sarcoidosis who present with what might appear as radiculopathy. While cervical spine MRI findings initially supported radiculopathy, history, examination, and work-up proved the diagnosis of brachial plexopathy.
Peripheral neuropathy occurs in 2–26% of systemic sarcoidosis cases. Brachial plexopathy as a presentation of neurosarcoidosis has been reported only once in literature, though several reports describe polyradiculoneuropathy or lumbar plexopathy as manifestations of neurosarcoidosis.
Conclusions:
This rare case of sarcoidosis-associated brachial plexopathy occurring alongside cervical radiculopathy highlights the importance of a broad differential diagnosis and thorough evaluation in patients with sarcoidosis presenting with focal neurological deficits. A high index of suspicion should be maintained for neurosarcoidosis even in the presence of structural spine pathology, as diagnosis can alter management and improve outcomes.
