Abstract

There have been allusions to the coincidence of sarcoidosis with Multifocal Motor Neuropathy in various series describing the conduction block neuropathy. We recently saw two patients with this association, the first a man in middle age with combined predominantly right median and radial neuropathies which responded completely to a 5-day course of IVIG at around the same time as he was diagnosed with pulmonary lymphadenopathy associated with sarcoidosis which resolved spontaneously. His neuropathy also resolved and did not need subsequent IVIG. The second patient had recognised NF1 and presented with acute onset of a left upper lumbosacral plexopathy and a left wrist drop with finger extension weakness and conduction block on Neurophysiology. She also had a history of benign sarcoidosis which had resolved spontaneously. A course of 5 days IVIG resolved her motor deficits which did not recur. These two cases demonstrate not only an interesting association with sarcoidosis, but also the unusual immediate response to one course of high dose IVIG without relapse in the neuropathy in a condition that is notorious for needing recurrent IVIG infusions. Moreover, one of our patients was a middle aged lady with lower limb involvement, both features being extremely unusual in this disorder which tends to be chronic despite continued immunotherapy and tends to affect particularly males, with the greatest majority affecting the upper limbs. These aspects and the association of the two conditions are discussed.