Neurosarcoidosis-Associated Transverse Myelitis: Rehab Course Following IV Steroid Therapy

Case Diagnosis: 65 year-old male with neurosarcoidosis-associated myelitis makes functional gains during inpatient rehabilitation stay.

Case Description or Program Description: A 65-year-old male with hypertension, hyperlipidemia, diabetes mellitus, and left eye blindness developed bilateral hand pain, initially attributed to trigger finger and diabetic neuropathy. Over the next month, his symptoms progressed to upper and lower extremity numbness, neck pain, saddle anesthesia, and gait instability. Cervical spine MRI confirmed transverse myelitis, and he received a one-week course of IV steroids. Further workup including CSF and serum analyses revealed elevated IL2R, raising suspicion for neurosarcoidosis. Despite multiple subsequent courses of IV steroids, his symptoms worsened and he was transferred to inpatient rehabilitation for management of functional decline.

On admission to rehabilitation, he exhibited impaired sensation, coordination, proprioception, and unsteady gait, placing him at high risk for falls. He required supervision or minimal assistance for bed mobility, transfers, and ambulation and received physical therapy to improve strength, coordination, and balance.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: By discharge, the patient demonstrated significant functional gains, achieving modified independence with bed mobility, requiring supervision for transfers, and ambulating 200 feet with a rolling walker and minimal assistance. His gait speed improved, and fall risk decreased.

Discussion (relevance): This is the first case report, to our knowledge, detailing the rehabilitation course of a patient with persistent neurosarcoidosis-associated myelitis. This presentation of transverse myelitis as a complication of neurosarcoidosis is unusual, making timely diagnosis and rehabilitation crucial for optimizing patient outcomes. This case underscores the essential role of inpatient rehabilitation in restoring functional mobility in patients with this rare complication.

Conclusions: Inpatient rehabilitation led to meaningful functional recovery, enabling the patient to regain independence despite persistent neurological deficits. This case highlights the importance of early and intensive rehabilitation in optimizing outcomes for patients with neurosarcoidosis-associated myelitis.