Neurosarcoidosis Presenting as New-Onset Epilepsy: When Chest Holds the Answer

Background: Sarcoidosis is a multisystem granulomatous inflammatory disorder of unknown etiology, characterized by noncaseating granulomas predominantly affecting lungs and lymph nodes. Neurosarcoidosis is a rare, potentially life-threatening complication of sarcoidosis where immune-mediated inflammatory cells (granulomas) affect the central or peripheral nervous system. Epilepsy in neurosarcoidosis is exceedingly rare in documentation with additional central nervous system, autonomic nervous system, and musculoskeletal system involvement. Case Presentation: We herein describe a rare case of a 20-year-old female who presented to the neurology outpatient department with a history of sudden loss of consciousness followed by severe headache and speech arrest. Clinical history of behavioral abnormalities in the past was not relevant. History obtained from the patient’s mother revealed a background of extreme fatigability and multiple joint pains involving small joints in a polyarticular distribution. Considering clinical history and symptom duration, initial metabolic and vasculitis workup was advised, which was essentially normal. Additionally, the patient reported intermittent diaphoresis and orthostatic dizziness, directing evaluation for orthostatic intolerance. Clinical examination confirmed significant postural hypotension. Given the multisystem involvement including musculoskeletal, autonomic, and cranial manifestations, vasculitis was retained as a differential diagnosis. Serum angiotensin-converting enzyme (ACE) levels and antinuclear antibody profile were ordered and it was found that ACE levels were moderately elevated. High-resolution computed tomography of the chest demonstrated bilateral hilar lymphadenopathy, raising strong suspicion for neurosarcoidosis. The patient was initiated with combination antiepileptic therapy alongside maintenance dose corticosteroids. The patient has shown satisfactory clinical improvement on the current regimen and remains under active follow-up. Conclusion: This case signifies extracranial and musculoskeletal causes of epilepsy to be kept in mind in young patients. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India