Treating CNS sarcoidosis with infliximab and mycophenolate mofetil

Abstract

Introduction: Neurosarcoidosis is a complication of systemic sarcoidosis that is frequently diffi cult to manage. Manifestations of central nervous system (CNS) sarcoidosis are quite variable. They include infi ltration of the optic nerve, perivascular retinopathy, leptomeningitis and pachymeningitis, chiasmal and hypothalamic lesions, cortical en plaque meningioma-like lesions, and spinal cord and cauda equina nodules and infi ltration. The rarity of this condition (5%– 10% of all sarcoidosis) makes any systematic randomized masked trial of treatment alternatives problematic. Most patients with neurosarcoidosis are treated with systemic corticosteroids with fair success. Problems arise when the neurosarcoidosis fails to yield to corticosteroids or fl ares as the corticosteroids are tapered, leading to the use of a long list of variably effective immunosuppressant alternative or adjunctive treatments [1]. None of these anecdotally recommended drugs have been subjected to a randomized prospective study. The paper by Moravan and Segal is typical of reports published since 2002 on the use of infl iximab as a next step in the treatment of corticosteroidand immunosuppressant drug–resistant CNS sarcoidosis.