title: Remission of refractory neurosarcoidosis treated with brain radiotherapy: a case report and a literature review.
abstract: Sarcoidosis is a chronic disease of unknown etiology characterized by the presence of T lymphocytes, mononuclear phagocytes, and noncaseating epithelioid granulomas in the tissues. Central nervous system involvement occurs in about 5% of the cases. The chronic form of neurosarcoidosis is particularly resistant to medical treatments. No universally accepted therapeutic protocols are currently available. Corticosteroids are the first line of therapy, but other immunosuppressive treatments are frequently added to the patient's regimen, although this strategy is not adequately supported by controlled clinical trials. For patients resistant to or not tolerating multiple alternate immunotherapeutic drugs, some authors suggest central nervous system radiotherapy. We present a case of a patient with neurosarcoidosis involving the hypothalamo-hypophyseal region and causing panhypopituitarism who had a poor response to and experienced severe side effects from conventional immunosuppressive treatments. The patient experienced a good clinical response to cranial irradiation. We review the literature on this subject.
authors.affiliation: Radiotherapy, Scientific Institute San Raffaele, Via Olgettina 60, Milan, Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: Motta
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
authors.forename: Angelo
authors.initials: A
authors.lastname: Bolognesi
authors.forename: Cesare
authors.initials: C
authors.lastname: Cozzarini
authors.forename: Nadia
authors.initials: N
authors.lastname: Di Muzio
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Fazio
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007027:Hypothalamic Diseases / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012507:Sarcoidosis / Q000473:pathology / Q000532:radiotherapy*