Thalidomide for acute treatment of neurosarcoidosis

Study design: Case report. Clinical setting: Johns Hopkins University School of Medicine, Baltimore, MD, USA. Case report: 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. Conclusion: Thalidomide is an immunomodulatory agent that acts to inhibit production of tumor-necrosis factor-α (TNF-α), an important mediator in CNS inflammation, by enhancing TNF-α 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. Disclosures: None.