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Thalidomide for acute treatment of neurosarcoidosis
E R Hammond1, A I Kaplin, D A Kerr
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287-5371, USA.
Study Design:
Case report.
Clinical Setting:
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Case Report:
Sarcoidosis is a multi-system granulomatous disease of unknown etiology with worldwide distribution. The involvement of the nervous system is common-neurosarcoidosis. Immune responses play an important role in the inflammatory process and granuloma formation. We report a case of neurosarcoidosis that was refractory to two courses of intravenous steroids. Upon initiation of oral thalidomide, the patient showed dramatic improvement clinically and on magnetic resonance imaging.
Conclusion:
Thalidomide is an immunomodulatory agent that acts to inhibit production of tumor-necrosis factor-alpha (TNF-alpha), an important mediator in CNS inflammation, by enhancing TNF-alpha mRNA degradation. Corticosteroids have been the mainstay of treatment of neurosarcoidosis with success at halting progression of the immune process in 50% cases. Thalidomide offers unique opportunities at managing CNS inflammation due to neurosarcoidosis.
Disclosures:
None.
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