0842 Narcolepsy or Sarcoidosis?

Abstract

Abstract Introduction Narcolepsy is a common cause of chronic sleepiness, affecting 1 in 2000 people. Despite the frequency of narcolepsy, the average time from the onset of symptoms to diagnosis is 5 to 15 years, and may remain undiagnosed in as many as half of all affected people. The etiology of this problem is largely unknown and usually multifactorial. The prevalence of these sleep disorders is increased in sarcoidosis compared to the general population. We present a case of narcolepsy in a patient with biopsy proven extrapulmonary sarcoidosis. Report of Cases: 42-year-old female has a history of Sjogren’s syndrome (SSA/SSB positive, ANA positive 1:160), antiphospholipid syndrome with past left lower extremity deep venous thrombosis and positive LAC and anticardiolipin antibody, and Raynaud’s syndrome for more than 15 years, asthma, pleurisy, irritable bowel syndrome, GERD, depression, migraine and fibromyalgia. Her primary sleep complaint is excessive daytime sleepiness and nonrestorative sleep requiring frequent napping. She exhibited intermittent hypnagogic hallucinations but denies cataplexy. She has no history of smoking and denies drinking caffeine/alcohol. Has 3-5 isolated awakenings at night otherwise denies insomnia. She had a score of 17 on the Epworth scale. Her in-lab polysomnography demonstrated an AHI of 0/hr, sleep latency of 4.5 minutes and REM latency of 31.5 minutes. No other abnormalities noted. She then underwent a multiple sleep latency test. Sleep was achieved in all the nap trials with a mean sleep latency of 1.2 minutes with three Sudden Onset REM Sleep recorded meeting criteria for narcolepsy. A subsequent PET/CT scan was obtained due to elevated liver enzymes and positive MRI findings, which incidentally showed a 2 mm enhancing focus involving the medial right cerebellar peduncle. She underwent biopsy which showed granulomatous disease consistent with sarcoidosis. Patient is currently successfully treated with methylphenidate for her underlying narcolepsy. Conclusion We present a patient with narcolepsy and multiple underlying autoimmune diseases including biopsy indicating extrapulmonary sarcoidosis. We, furthermore, present radiographic evidence in her brain that may have contributed to her narcolepsy. Support (If Any)