Thalidomide for acute treatment of neurosarcoidosis.
METHODS
Case report.


METHODS
Johns Hopkins University School of Medicine, Baltimore, MD, USA.


METHODS
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.


CONCLUSIONS
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.


BACKGROUND
None.
Hammond
E R
ER
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287-5371, USA.
Kaplin
A I
AI
Kerr
D A
DA
D000328:Adult; D001921:Brain / Q000473:pathology; D006099:Granuloma / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D011434:Proprioception; D012507:Sarcoidosis / Q000188:drug therapy* / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000188:drug therapy* / Q000473:pathology; D013792:Thalidomide / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D013792:Thalidomide