A CASE OF NEUROSARCOIDOSIS SUCCESSFULLY TREATED WITH RITUXIMAB

Abstract

Involvement of the CNS is estimated in about 5% of patients with systemic sarcoidosis and less than half manifest isolated CNS disease.1 The diagnosis of definite neurosarcoidosis requires tissue biopsy demonstrating noncaseating granulomas in the absence of organisms or other causes.2 Corticosteroids are the mainstay of therapy and in one case series, over 70% of patients relapsed or progressed despite treatment with corticosteroids and oral immunosuppressant agents.3 Successful use of infliximab in cases of neurosarcoidosis has been described.4 Here we report a case of a patient who failed to respond to steroids and immune therapies and remained stable after treatment with B-cell-depleting therapy. This being a case report of one patient without blinded observation for treatment, it is a Class IV study. ### Case report. A 50-year-old, right-handed white woman presented with clumsiness affecting the right upper extremity. Within a few days, the deficit progressed to complete loss of strength of the right upper extremity. MRI of the brain revealed multiple lesions in the bilateral hemispheres, some of which enhanced postcontrast (figure, A–C). CSF showed 3 cells, protein 47 mg/dL (normal 15–45), glucose 66 mg/dL (normal 40–70), immunoglobulin G index 0.51 (normal 0.28–0.66), synthesis rate 0.0 mg/day (normal 0–8), negative oligoclonal bands, and myelin basic protein 6.63 ng/mL (normal 0.07–4.1). CT chest, abdomen, and pelvis, bone scans, conventional …