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Area of Science:

  • Neurology
  • Immunology
  • Radiology

Background:

  • Systemic sarcoidosis patients with CNS disorders are often presumed to have neurosarcoidosis (NS).
  • However, co-occurring multiple sclerosis (MS) must be considered if presentation and course are atypical for NS.

Purpose of the Study:

  • To propose a diagnostic approach for patients with sarcoidosis and potential comorbid MS.
  • To differentiate between neurosarcoidosis and multiple sclerosis in complex cases.

Main Methods:

  • Retrospective chart review across four academic MS centers.
  • Inclusion criteria: diagnosis of MS (2017 McDonald criteria) and biopsy-confirmed extraneural sarcoidosis.
  • Data abstraction focused on demographic, clinical, and paraclinical characteristics relevant to NS and MS.

Main Results:

  • Ten patients (80% female, mean age 47.7) met criteria, with biopsy-proven sarcoidosis.
  • MS diagnosis confirmed by clinical relapses, characteristic MRI demyelination, and typical disease evolution over 7 years.
  • No "red flag" NS features (meningeal enhancement, hydrocephalus, pituitary involvement) were observed; all patients received MS disease-modifying therapy.

Conclusions:

  • A rational diagnostic approach is proposed for sarcoidosis patients with possible comorbid MS.
  • Equivocal cases favor MS diagnosis with "MS-typical lesions" and absence of "NS-typical lesions" on MRI.
  • Close follow-up is essential to confirm clinical and radiologic evolution and response to MS therapies.