title: A case of neurosarcoidosis secondary to treatment of etanercept and review of the literature.
abstract: There are only three cases in the literature that describe development of neurosarcoidosis in a patient who is on tumour necrosis factor α inhibitors. We describe a case of a 33-year-old woman with a history of juvenile rheumatoid arthritis and refractory uveitis (with previous treatment trials of adalimumab, infliximab, mycophenolate, methotrexate) who had been stable for 2 years on etanercept. She was diagnosed with biopsy-proven systemic sarcoidosis with meningeal and parenchymal neurosarcoidosis. She was switched to infliximab and methotrexate, with clinical and imaging improvements. This is a case that demonstrates the difficulty of choosing tumour necrosis factor α (TNF-α) inhibitors when treating patients with multiple clinical autoimmune entities. It is also a case where a change in the mechanism of TNF-α inhibition pathway can still be used to treat refractory sarcoidoisis and rheumatoid arthritis. It is still unclear what the exact difference between the TNF-α blockers and their neurological complications is, and who the patients at risk of developing neurological complications are.
authors.affiliation: Department of Neurology, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA.
authors.forename: Idanis
authors.initials: I
authors.lastname: Berrios
authors.affiliation: Department of Neurology, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA.
authors.forename: Adalia
authors.initials: A
authors.lastname: Jun-O'Connell
authors.affiliation: Department of Neurology, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA.
authors.forename: Sorina
authors.initials: S
authors.lastname: Ghiran
authors.affiliation: Department of Neurology, University of Massachusetts School of Medicine, Worcester, Massachusetts, USA.
authors.forename: Carolina
authors.initials: C
authors.lastname: Ionete
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000150:complications / Q000188:drug therapy*; D002493:Central Nervous System Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D003072:Cognition Disorders / Q000209:etiology* / Q000503:physiopathology; D000068800:Etanercept / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014605:Uveitis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept; D008727:Methotrexate