MS and Sarcoidosis

Medically Reviewed by Christopher Melinosky, MD on June 07, 2024
6 min read

Multiple sclerosis (MS) can cause a wide variety of symptoms. You may have brain fog, weakness or numbness in an arm or leg, an unsteady walk, changes to how you see or speak, or fatigue.

MS symptoms can be very different in each person. For a while, your symptoms may come and go. MS can be mistaken for many other conditions, including sarcoidosis.

MS and sarcoidosis can mimic each other. Your doctor will do some medical tests to be sure you have the correct diagnosis and treatment, so you reduce inflammation, feel better, and prevent nerve and organ damage. You also don’t want to take the wrong medication and get worse.

Sarcoidosis is a chronic disease that causes inflammation. If you have this condition, you’ll develop inflamed lumps of tissue called granulomas in different organs, usually your lungs and lymph nodes.

Sarcoidosis can affect other parts of the body too:

About 5% to 15% of people with sarcoidosis have disease that affects their nervous system. This type is called neurosarcoidosis. Neurosarcoidosis can cause inflammation in your brain, spinal cord, and nerves all over your body, including your optic or eye nerves.

Sarcoidosis and MS are alike in a few key ways:

  • Both diseases are chronic, or long-lasting.
  • Both cause inflammation that can damage your body’s nerves, organs, and tissues.
  • Both seem to be linked to problems in your immune system.
  • Both can cause lesions that show up on an imaging test like an MRI.
  • Both may have periods when symptoms flare or ebb (relapses), or steadily worsen over time.
  • Both diseases make you more likely to have depression.
  • Both diseases may be triggered by an infection. Some experts think there’s a link between MS and infection with the Epstein-Barr virus. Sarcoidosis may also be triggered by some type of infection, possibly a bacterial bug called P. acnes.

If you have neurosarcoidosis, inflammation can wear down and damage myelin, a thin sheath of tissue that coats and protects your nerves. MS also causes inflammation that damages myelin and your nerves.

Neurosarcoidosis can affect nerves in many parts of your body. Often, it affects nerves around your face and head, brain, eyes, and the pituitary gland that sits inside your head behind your nose. Your pituitary gland makes hormones that regulate many of your body’s functions, including blood pressure, maintaining muscles and bones, and energy and metabolism.

Neurosarcoidosis and MS could have many of the same symptoms, like these:

  • Cognitive changes, like brain fog, forgetting words, or being slow to process new information
  • Dizziness or loss of balance
  • Changes to your gait or movements
  • Fatigue
  • Facial paralysis: a drooping face or weak facial muscles
  • Muscle weakness
  • Numbness
  • Tingling sensations
  • Changes to your eyesight, like vision loss, double vision, or blurry vision
  • Speech changes like slurring
  • Pain
  • Hearing loss

Similar complications: People with either sarcoidosis or MS could have these serious complications:

  • Uveitis, an inflammation of tissue inside the eye’s wall that causes redness, pain, and blurry vision
  • Optic neuritis, an inflamed nerve in your eye that can cause eye pain, blurry vision, or vision loss
  • Myelopathy, compression or squeezing of your spinal cord that can cause pain, numbness, or changes in how you move

Similar imaging: People with either neurosarcoidosis or MS can have lesions on their brain’s white matter that show up on imaging tests like an MRI. Your scans may show multiple lesions or spots.

Your radiologist will review your MRI scans carefully to look for differences between lesions that are typical for sarcoidosis or those that are more likely due to MS.

In about 90% of people with sarcoidosis, the disease mainly affects their lungs. They have a nagging cough and shortness of breath. Rashes and skin bumps are also common in sarcoidosis. MS doesn’t cause coughs or skin rashes.

Also, MS is far more common than sarcoidosis:

  • Close to 1 million Americans have MS, much higher than we estimated in the past.
  • It’s estimated that 150,00-200,000 Americans have sarcoidosis.
  • Neurosarcoidosis is even rarer. Only 5%-15% of people with sarcoidosis have disease that affects their nervous system.

Racial/ethnic differences: Sarcoidosis is much more common among Black people than white people. MS is more common in white people, particularly people with Scandinavian ancestry, than Black people.

Different disease courses:

  • People with MS often have symptoms that come and go for years. This is called relapsing-remitting disease. Later on, most people have symptoms that get worse.
  • Some people with milder MS don’t need any treatment to manage their symptoms, but most do need treatment to relieve flares or slow down their disease.
  • Up to 70% of people with sarcoidosis have symptoms that go away on their own with no treatment, while the other 40% do need treatment. Some people with sarcoidosis can die from its complications unless they start taking medications.

Autoimmune vs. immune-related

Scientists classify MS as an autoimmune disease. Your immune system attacks your own healthy nerves for some reason.

Sarcoidosis is when your immune system overreacts, causing inflammation and granulomas. But some experts don’t think sarcoidosis is an autoimmune disease. Your immune system doesn’t attack your own body in sarcoidosis. It just overreacts for some unknown reason.

Because MS and sarcoidosis can mimic each other, your doctor will want to do some tests to be sure you have the right diagnosis.

Spinal tap: Your doctor may give you a spinal tap or lumbar puncture test. They’ll insert a needle into the sack around your spine to draw out a sample of cerebrospinal fluid (CSF) to examine. This is a very useful test to show whether you have sarcoidosis or MS.

While a spinal fluid test isn’t used much to diagnose MS, it’s a good test to rule out other causes of your symptoms if other test results aren’t clear.

  • Both MS and neurosarcoidosis can cause slightly higher white blood cells, total protein, and angiotensin-converting enzyme (ACE) results. But big spikes in these three results are more common for sarcoidosis. They’re rare for people with MS.
  • Up to 98% of people with MS test positive for oligoclonal immunoglobulin. This result is rare for people with sarcoidosis.

Brain and spinal cord MRI: Your doctor may do an MRI of your brain and spine. MRI scans show a lot of detail to help make a diagnosis of either MS or sarcoidosis. An MRI scan can also help guide your doctor to places where they can take a biopsy or tissue sample.

An MRI can show lesions that are similar in sarcoidosis and MS. Your radiologist will look for specific details, like the shape or exact location of these lesions, to tell if they’re due to sarcoidosis or MS.

MS typically causes lesions in the white matter of the brain and the spinal cord. Sarcoidosis causes lesions called granulomas that can build up in many organs, like the lungs, lymph nodes, skin, and sometimes the spine, brain, or nerves.

Biopsy: Your doctor may remove and test a small sample of tissue from your lung, nerve, spinal cord, or brain to confirm that you have sarcoidosis, not MS. People with sarcoidosis will often have a specific type of lesion called a noncaseating granuloma.

Chest imaging: A chest X-ray or CT scan can provide more clues. Sarcoidosis most often affects the lungs, but it can also affect the brain and nerves, causing MS-like symptoms.

It may be possible to have both sarcoidosis and MS. Some people may have granulomas in different organs, but also have signs of MS, like damage to the myelin on their nerves and relapses. It’s very rare to have both.