Life-threatening multisystem sarcoidosis with neurological, renal, ocular and autoimmune haemolytic manifestations treated with intravenous immunoglobulin, plasma exchange, cyclophosphamide and infliximab.
Kalpa Jayanatha, Mark Sapsford, Alexandra Chaptynova et al.
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Case in brief
A patient with multisystem sarcoidosis presented with encephalopathy, acute tubulointerstitial nephritis, optic neuritis, and autoimmune hemolytic anemia, resembling a stroke. Despite extensive immunological testing yielding no diagnosis, her neurological and hematological symptoms improved with intravenous methylprednisolone, immunoglobulin, and plasma exchange. Complications included steroid-induced glaucoma and diabetes, but her ocular and renal conditions achieved complete remission with infliximab therapy.
What made this case unusual
This case uniquely highlights multisystem sarcoidosis presenting as a stroke mimic with severe renal impairment and concurrent hemolysis, which has not been previously described.
Diagnostic / clinical pearl
Clinicians should consider multisystem sarcoidosis in patients presenting with neurological symptoms and renal impairment, especially when standard immunological tests are inconclusive.
Why it matters
The use of plasma exchange in treating sarcoidosis is not well established, making this case significant for understanding potential therapeutic options in severe presentations.