The pathogenesis and treatment of optic disc swelling in neurosarcoidosis - A unique therapeutic response to infliximab

Objective: To review the pathogenesis and treatment of optic disc swelling in neurosarcoidosis, including a novel therapeutic response to infliximab. Design and Setting: Case reports from an inpatient neurology service. Patients: A 35-year-old woman presented with headache, chronic visual loss, papilledema, and optic atrophy, characteristic of chronic intracranial hypertension. Magnetic resonance imaging showed bifrontal cerebral edema with en plaque frontal pachymeningeal enhancement. Her visual loss progressed despite conventional therapies. The use of the tumor necrosis factor a antagonist infliximab maintained functional vision in her right eye. A 57-year-old woman presented with bilateral, subacute, painful visual loss and unilateral papillitis consistent with optic neuritis. Her visual loss responded rapidly to intravenous corticosteroids. The funduscopic examination findings in both patients prompted further clinical investigation, culminating in the diagnosis of neurosarcoidosis. Conclusion: Understanding the multiple etiologic mechanisms that produce optic disc swelling in sarcoidosis can help neurologists tailor treatment for patients with neurosarcoidosis who present with this symptom.