Introduction Multiple sclerosis causes a variety of clinical neurological features which may overlap with sarcoidosis with central nervous system involvement. Rarely, concurrent diagnosis of MS and sarcoidosis in an individual has been reported. Currently, best management strategy for these individuals with this dual pathology remains unknown.
Case A 54-year-old man with a 14-year history of isolated ocular sarcoidosis, as well as type 2 diabetes mellitus, hypertension, and dyslipidemia, presented with ongoing right-hand paresthesia. Gadolinium-enhanced neuroaxis MRI imaging revealed comparatively stable non-enhancing appearances of previously known numerous punctate supratentorial subcortical white matter hyperintensities, and a new non-enhancing right ventrolateral C3/4 cervical spinal cord hyperintense lesion. The radiological pattern in combination with positive oligoclonal bands and elevated protein levels on cerebrospinal fluid testing, with normal serum ACE level, was thought to favour a diagnosis of multiple sclerosis (with McDonald criteria fulfillment), rather than neurosarcoidosis. In addition to his sarcoidosis treatment comprising prednisolone and hydroxychloroquine (later changed to mycophenolate), Ocrelizumab was selected as initial disease modifying therapy for his new relapsing remitting multiple sclerosis, due to postulated benefits for his sarcoidosis as well based on ocrelizumab’s similarity to rituximab, an established treatment option in refractory sarcoidosis.
Conclusion This case highlights several key issues:
Recognising the possibility of co–occurrence of CNS demyelinating disease in sarcoidosis
The diagnostic challenge of ascertaining new neurological changes in sarcoidosis
The challenge of managing concurrent inflammatory conditions of distinctly separate aetiology
We propose that Ocrelizumab has potential utility as an option in streamlining therapeutic management of this dual pathology.
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