Dramatic MRI improvement with refractory neurosarcoidosis treated with infliximab

Background - Neurosarcoidosis is often a devastating, refractory condition without definite pharmacotherapies beyond corticosteroids. Aim - To describe a case of steroid-refractory neurosarcoidosis with a marked clinical and radiological response to infliximab. Methods - We describe the case of a young female patient with biopsy-proven neurosarcoidosis leading to gait failure. She described significant corticosteroid-related side effects without clinical response to the therapy. Infliximab therapy was considered as a possible rescue medication. Results - Within months of starting intravenous infliximab therapy, she regained her ability to walk and magnetic resonance imaging identified significant improvements over a sustained course of infliximab therapy, including loss of enhancing nodules and loss of meningeal enhancement. Conclusion - Mounting evidence suggests that infliximab is a valuable pharmacological agent in the management of patients with refractory and disabling neurosarcoidosis. Controlled studies of infliximab in this condition are needed.