Rapid Overnight Efficacy of Infliximab Treatment in Neurosarcoidosis A Clinical Breakthrough

Abstract

Objectives

Approximately 5% of sarcoidosis patients develop central nervous system involvement, causing significant morbidity that demands prompt intervention. Spinal cord manifestations represent an exceptionally uncommon presentation. For severe, treatment-resistant cases, the tumor necrosis factor-α inhibitor infliximab shows promising efficacy as an alternative neurosarcoidosis treatment, though standardized protocols remain undeveloped

Methods

We present a patient with severe corticosteroid-refractory spinal cord sarcoidosis who exhibited dramatic overnight response to infliximab therapy. Additionally, we conducted a literature review examining infliximab effectiveness in neuroinflammation treatment, drawing comparisons with established practices in other medical disciplines to inform decisions regarding treatment initiation and discontinuation.

Results

Our PubMed search identified 34 case reports documenting successful infliximab use in refractory neurosarcoidosis. Of these, 19 cases specified time to therapeutic response. Mirroring our patient's experience, 14 cases demonstrated improvement between the first and third infusion. Eight cases maintained remission following infliximab discontinuation. No consistent treatment protocol emerged across reports.

Conclusions

Infliximab demonstrates rapid-acting efficacy for severe sarcoidosis brain inflammation treatment. The absence of controlled trials precludes systematic treatment strategies for refractory neurosarcoidosis. Until definitive evidence emerges, clinicians may adapt therapeutic approaches from other medical specialties where infliximab protocols are well-established.

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