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Sarcoidosis is an idiopathic inflammatory disease characterized by granulomatous infiltration of multiple organs including the brain. The natural history is highly variable and neurologic involvement has been associated with greater resistance to treatment and increased overall morbidity and mortality.1,2⇓ Corticosteroids are the mainstay of treatment but adjuvant approaches with antimalarials, cyclosporine, cytotoxic agents, and the anti–tumor necrosis factor-alpha (TNFα) agents thalidomide and pentoxifylline have been associated with some degree of disease response.3 Increasing evidence suggests that TNFα plays a pivotal role in the inflammatory cascade of this disease4,5⇓ and recent observations suggest a beneficial response of refractory systemic sarcoidosis to infliximab, a chimeric monoclonal human-murine antibody directed against TNFα.6,7⇓
We describe a case of refractory neurosarcoidosis in which the patient responded dramatically to infliximab therapy.
Case report.
Case presentation.
A 46-year-old man developed biopsy-proven sarcoidosis 16 years previously initially involving the skin (lupus pernio) and subsequently the liver (granulomatous hepatitis), knees (synovitis), lungs (hilar lymphadenopathy), and brain (left temporal lobe lesion with associated focal …
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- Refractory neurosarcoidosis responding to infliximab
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