Neurosarcoidosis as a cause of refractory psychosis: a complicated case report.

Abstract

T his report describes the psychiatric presentation and clinical course of a man who was eventually diagnosed with neurosarcoidosis. He presented with a past history of depressive symptoms and intermittent psychosis. His previous psychiatric diagnoses included schizophrenia, schizoaffective disorder, and dementia. He had been hospitalized numerous times before the establishment of his diagnosis, with multiple unsuccessful attempts at psychiatric management of symptoms that included hallucinations, disorganization, and confusion. Sarcoidosis is a rare disorder (10.9– 35.5 cases per 100,000) and involves the central nervous system (CNS) in approximately 5% of cases. In addition to neurologic signs and symptoms, psychiatric presentations of neurosarcoidosis may include symptoms of delirium, dementia, depression, personality changes, and psychosis. Because CNS sarcoidosis is a treatable disease that may present with psychiatric symptoms, it is important that mental health professionals become aware of the neuropsychiatric manifestations of this disease. The complexity of this illness and difficulties in differential diagnosis are described in this report.