Sodhi Manica, Pearson Karla, White Eric S, Culver Daniel A
Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Respir Med. 2009 Feb;103(2):268-73. doi: 10.1016/j.rmed.2008.08.016. Epub 2008 Oct 2.
Central nervous system involvement is a severe manifestation of sarcoidosis that often requires aggressive immunosuppressive therapy. The most efficacious approach for refractory disease is unknown. We reviewed the cases of four subjects who demonstrated active progression of neurosarcoidosis while under treatment with cyclophosphamide, and who were subsequently treated with infliximab. All four subjects demonstrated rapid and substantial reversal of their clinical course. Radiologic findings were concordant with the clinical responses. There were no notable toxicities. Treatment with infliximab may be more effective than cyclophosphamide for refractory central nervous system sarcoidosis. A larger, prospective study is warranted.
中枢神经系统受累是结节病的一种严重表现，通常需要积极的免疫抑制治疗。对于难治性疾病，最有效的治疗方法尚不清楚。我们回顾了4例在接受环磷酰胺治疗时神经结节病仍有活动进展，随后接受英夫利昔单抗治疗的患者病例。所有4例患者的临床病程均迅速且显著逆转。影像学检查结果与临床反应一致。未出现明显毒性反应。对于难治性中枢神经系统结节病，英夫利昔单抗治疗可能比环磷酰胺更有效。有必要进行一项更大规模的前瞻性研究。
