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Symmetric sarcoid polyneuropathy

Analysis of a sural nerve biopsy

Division of Neuropathology, Department of Pathology (Drs. Nemni and Hays) and the Department of Neurology (Drs. Galassi, Cohen, Singh, Bressman, Gould, and Gamboa), Columbia Presbyterian Medical Center, New York, NY.

A 20-year-old woman with sarcoidosis had uveitis, subacute symmetric sensorimotor neuropathy, and noncaseous granulomas in biopsies of gastrocnemius muscle and sural nerve. Morphologic studies of the nerve confirmed the electrodiagnostic impression of an acute axonal and demyelinating neuropathy. Of 100 teased myelinated nerve fibers, 15% contained myelin ovoids and 24% demonstrated segmental demyelination. Quantitative analysis showed a reduction in the numerical density of myelinated fibers. By electronmicroscopy, unmyelinated fibers were largely spared. The exact mechanism of nerve fiber damage was not determined, but a local effect of the granuloma seemed likely, because most lesions were found in the endoneurium.

Address correspondence and reprint requests to Dr. Hays, Department of Pathology, College of Physicians and Surgeons, 630 West 168 Street, New York, NY 10032.

Supported by Center Grants from the National Institute of Neurological and Communicative Disorders and Stroke (No. NS-11766-06) and from the Muscular Dystrophy Association.

This work was presented in part at the thirty-second annual meeting of the American Academy of Neurology, New Orleans, LA, May 1980.

Accepted for publication March 24, 1981.

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