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Tennessee Medicine E-Journal

Abstract

The standard treatment of neurosarcoidosis involves a high dose of methylprednisolone followed by a prolonged course of prednisone; thus, the majority of patients must endure treatment that invariably generates numerous complications. Recurrence of neurological symptoms and/or persistence of magnetic resonance imaging (MRI) findings are not uncommon. Intravenous cyclophosphamide is a known mode of treatment that is usually reserved for either steroid-resistant cases or patients who cannot tolerate steroids. We describe a 49 year-old male who presented with progressive gait imbalance, decreased hearing and tinnitus associated with headache, weight loss and fever. By assessment of clinical features, imaging and histopathology, a diagnosis of neurosarcoidosis with multi-organ involvement was established. The patient was treated with two one-gram doses of methylprednisolone, followed by rapidly-tapered prednisone. Azathioprine was added in follow-up; however, MRI of the brain showed disease progression. Seven infusions of cyclophosphamide were given for treatment, resulting in complete symptomatic improvement and resolution of radiographic signs of active central nervous system sarcoidosis. We conclude that cyclophosphamide is a safe and reliable treatment option for neurosarcoidosis.

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