Steroid-unresponsive neurosarcoidosis successfully treated with adalimumab

Marnane, Michael; Lynch, Timothy; Scott, Jacqueline; Stack, John; Kelly, Peter

doi:10.1007/s00415-009-0077-1

Cited by 37 publications

(17 citation statements)

References 8 publications

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“…Biopsy of mass lesions is recommended for a definitive diagnosisBehaviour change, confusional states and psychosis are reportedHypothamic and pituitary dysfunction [2, 6, 8, 9, 20, 22, 28, 29, 44–46]Usually of insidious onset, due to suprasellar inflammatory lesions. The most eminent symptoms are bitemporal visual failure, polydipsia and polyuria (diabetes insipidus), and galactorrhoeaSymptoms may arise from hypothalamic dysfunction, hypopituitarism or compression of the optic chiasm by mass effectAn aseptic meningitis is often seenMyopathy [6, 19, 20, 22, 38]Usually asymptomatic. Where symptomatic, this presents as proximal weakness.…”

Section: Diagnosismentioning

confidence: 99%

Neurosarcoidosis: a clinical approach to diagnosis and management

2016

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Sarcoidosis is a rare but important cause of neurological morbidity, and neurological symptoms often herald the diagnosis. Our understanding of neurosarcoidosis has evolved from early descriptions of a uveoparotid fever to include presentations involving every part of the neural axis. The diagnosis should be suspected in patients with sarcoidosis who develop new neurological symptoms, those presenting with syndromes highly suggestive of neurosarcoidosis, or neuro-inflammatory disease where more common causes have been excluded. Investigation should look for evidence of neuro-inflammation, best achieved by contrast-enhanced brain magnetic resonance imaging and cerebrospinal fluid analysis. Evidence of sarcoidosis outside the nervous system should be sought in search of tissue for biopsy. Skin lesions should be identified and biopsies taken. Chest radiography including high-resolution computed tomography is often informative. In difficult cases, fluorodeoxyglucose positron emission tomography and gallium-67 imaging may identify subclinical disease and a target for biopsy. Symptomatic patients should be treated with corticosteroids, and if clinically indicated other immunosuppressants such as hydroxychloroquine, azathioprine, cyclophosphamide or methotrexate should be added. Anti-tumour necrosis factor alpha therapies may be considered in refractory disease but caution should be exercised as there is evidence to suggest they may unmask disease.

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Section: Diagnosismentioning

confidence: 99%

Neurosarcoidosis: a clinical approach to diagnosis and management

2016

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“…In such scenarios, the addition of TNFa-neutralizing or blocking agents can be ameliorative. Several series attest to the efficacy of human IgG1 anti-TNFa monoclonal antibodies, namely, infliximab and adalimumab (Moravan and Segal, 2009;Marnane et al, 2009;Sodhi et al, 2009). Of note, anti TNFa therapy has been associated with the onset and/or exacerbation of multiple sclerosis as well as reactivation of tuberculosis and the development of lymphoma (Matsumoto et al, 2013;Sicotte and Voskuhl, 2001).…”

Section: Treatmentmentioning

confidence: 98%

Neurosarcoidosis as an MS Mimic: The trials and tribulations of making a diagnosis

MacLean

Abdoli

2015

Multiple Sclerosis and Related Disorders

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“…Another TNF-a antagonist, adalimumab, has also been found to be beneficial in corticosteroid-refractory neurosarcoidosis. 44 Major side effects include progressive multifocal leukoencephalopathy, lymphoma, and reactivation of tuberculosis, all of which should be considered in sarcoidosis patients who develop new neurologic findings while on TNF-a antagonists.…”

Section: Tumor Necrosis Factor-a Antagonistsmentioning

confidence: 99%

Neurosarcoidosis

Tavee

Stern

2015

Clinics in Chest Medicine

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Neurosarcoidosis is known as the great mimicker and may appear similar to lymphoma, multiple sclerosis, and other diseases affecting the nervous system. Although definitive diagnosis requires histologic confirmation of the affected neural tissue, characteristic clinical manifestations, gadolinium-enhanced MRI patterns and specific cerebrospinal fluid findings can help support the diagnosis in the absence of neural biopsy. An understanding of the common clinical presentations and diagnostic findings is central to the evaluation and management of neurosarcoidosis.

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Steroid-unresponsive neurosarcoidosis successfully treated with adalimumab

Cited by 37 publications

References 8 publications

Neurosarcoidosis: a clinical approach to diagnosis and management

Neurosarcoidosis: a clinical approach to diagnosis and management

Neurosarcoidosis as an MS Mimic: The trials and tribulations of making a diagnosis

Neurosarcoidosis

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