The prognosis with sarcoidosis can vary widely. Case studies show that two-thirds of patients may have a nonrecurring illness. Among the remaining one-third, the disease course may be relapsing-remitting or progressive. When confronted with an acute neurologic event, consider recurrent sarcoidosis and coordinate care between specialists. Also, take steps to prevent complications related to prolonged steroid use.
TABLE 2
Treatment of neurosarcoidosis3
Medication* | Side effects | Comments |
---|---|---|
Methylprednisolone | Hyperglycemia | |
Prednisone | Osteoporosis, hyperglycemia, hypertension, diabetes, glaucoma, cataracts, psychosis, Cushing’s syndrome | Taper as able. Concomitant use of cytotoxic agents may facilitate taper. Monitor glucose and give calcium/vitamin D prophylaxis |
Methotrexate | Anemia, neutropenia, liver damage | Weekly dosing well tolerated. Give folic acid 1 mg/d. Monitor liver function tests periodically |
Cyclosporine | Renal insufficiency, hypertension | |
Azathioprine | Anemia, neutropenia, liver damage | |
Cyclophosphamide | Cystitis, neutropenia | Monitor urine monthly for microscopic hematuria |
Hydroxychloroquine | Retinopathy, hypoglycemia, ototoxicity, myopathy, cardiomyopathy, neuropathy | Refer for eye exams every 3-6 months. May be useful to counteract hyperglycemic effect of steroids |
Infliximab | Fever, headache, dizziness, flushing, abdominal pain, dyspepsia, myalgia, arthralgia, polyneuropathy | Screen for tuberculosis before starting treatment. Contraindicated in patients with congestive heart failure |
*For dosing details, consult a neurologist or rheumatologist |
Improvement for our patient
Based on cerebrospinal fluid study results, a positive peripheral lymph node biopsy, and the exclusion of other diagnoses, we regarded the diagnosis of sarcoidosis as highly probable and initiated high-dose intravenous corticosteroids. Over several weeks, our patient gradually improved with physical therapy and was walking unassisted at the time of discharge from a hospital-based rehabilitation unit. Repeat MRI scans showed a reduction in the size of her intradural lesions, and we slowly tapered her steroids.
CORRESPONDENCE
Hillary R. Mount, MD, 2123 Auburn Avenue,#340, Cincinnati, OH 45219; hillary.mount@thechristhospital.com