Chest
Selected ReportsTreatment of Corticosteroid-Resistant Neurosarcoidosis With a Short-Course Cyclophosphamide Regimen
Section snippets
Patients and Methods
Patients were selected from those followed up at the Sarcoidosis Center at the Medical University of South Carolina. Between September 1998 and June 2002, 451 patients were seen at our center. Thirty-seven patients met either definite or probable criteria by the Case Control Etiologic Study of Sarcoidosis9 instrument for the diagnosis of neurosarcoidosis. We identified patients whose neurosarcoidosis was refractory to conventional therapy with corticosteroids or who were unable to tolerate
Results
Seven patients with refractory neurosarcoidosis were selected for cyclophosphamide therapy. The baseline characteristics of the patients receiving cyclophosphamide are summarized in Table 1. Table 2 describes the diagnostic criteria met by each patient and the specific neurologic manifestations.
The clinical course is summarized in Table 3. All patients were receiving corticosteroids at the time of cyclophosphamide initiation, with an average dose of 42 mg/d. The duration of therapy with
Discussion
Traditionally, high-dose corticosteroids have been the standard of care for treatment of neurosarcoidosis. Unfortunately, a significant percentage of patients with neurosarcoidosis have disease refractory to corticosteroids or are unable to tolerate the high doses that are often required for effective treatment.2 In recent years, attention has been turned to the use of cytotoxic and noncytotoxic agents as corticosteroid-sparing agents. Methotrexate, cyclosporine, chlorambucil, azathioprine,
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