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Isolated neurosarcoidosis mimicking multiple sclerosis.
1College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Kingdom of Saudi Arabia.
Neurosciences (Riyadh, Saudi Arabia)
|January 18, 2021
Summary
Neurosarcoidosis (NS) can mimic multiple sclerosis (MS), leading to misdiagnosis. Prompt diagnosis and appropriate treatment, such as with prednisone and infliximab, are crucial for managing NS neurological symptoms.
Area of Science:
- Neurology
- Immunology
Background:
- Neurosarcoidosis (NS) presents with neurological symptoms that can be mistaken for other neurological conditions, notably multiple sclerosis (MS).
- Accurate differentiation is essential as treatments and prognoses differ significantly.
Observation:
- A case study of a 25-year-old male presenting with transverse myelitis is detailed.
- Initial presentation included brain and spinal cord white matter lesions on MRI, leading to an MS diagnosis and treatment with fingolimod.
- Lack of improvement and subsequent MRI revealed longitudinally extensive lesions with leptomeningeal enhancement.
Findings:
- Leptomeningeal and cerebellar biopsy confirmed non-necrotizing granulomas, indicative of neurosarcoidosis.
- Treatment with fingolimod was discontinued due to lack of efficacy.
- Initiation of oral prednisone and infliximab halted disease progression and facilitated gradual improvement.
Implications:
- Highlights the critical importance of distinguishing between neurosarcoidosis and multiple sclerosis.
- Underscores the potential harm of administering incorrect therapies, such as fingolimod for NS.
- Emphasizes the effectiveness of immunosuppressive therapy (prednisone, infliximab) in managing neurosarcoidosis.
