Sarcoidosis with neurological involvement imitating multiple sclerosis: The importance of thoracic imaging.

A 30-year-old man with no significant history presented in the emergency department in 2007 with loss of vision. A campimetric defect indicative of optic neuritis was confirmed. In view of these findings, corticosteroid treatment (1 g/day for 5 days) was administered, and magnetic resonance imaging (MRI) of the head was performed. No radiological studies of the chest were performed during this episode. The head MRI (Fig. 1) showed focal lesions in the white matter, indicative of demyelinating disease. Since the patient did not meet all the criteria for multiple sclerosis (MS) and had presented no new episodes of neurological symptoms during follow-up, no specific MS treatment was initiated and the patient continued follow-up on an outpatient basis. Several follow-up head MRIs were performed, showing mild disease progression with no clinical repercussions, and the presumed diagnosis of MS was maintained. Six years after this episode, the patient presented with cough and dyspnea. A chest X-ray (Fig. 2A) showed widened mediastinum, enlarged pulmonary hila, and interstitial involvement. In view of the radiological suspicion of sarcoidosis, a chest CT was performed. Multiple lymphadenopathies