Abstract Details

Title Neurosarcoidosis Management in Pregnancy: A Review and Longitudinal Case Study

Topic Autoimmune Neurology

Presentation(s) P6 - Poster Session 6 (11:45 AM-12:45 PM)

Poster/Presentation
Number 8-015

Objective (1) To present a longitudinal case study illustrating the complexities of managing neurosarcoidosis through diagnosis, pregnancy, and postpartum periods. (2) To provide practical guidance for clinicians managing patients with neurosarcoidosis who are pregnant or considering pregnancy based on a literature review and current case.

Background Neurosarcoidosis presents unique challenges during pregnancy, requiring a delicate balance between maternal health and fetal well-being. We aim to review current literature on neurosarcoidosis management in pregnancy and present a detailed longitudinal case study.

Design/Methods We conducted a comprehensive literature review using PubMed, Embase, and Cochrane Library databases (2000-2024). A longitudinal case study of a young woman with neurosarcoidosis managed through diagnosis, pregnancy, and postpartum period is presented.

Results Neurosarcoidosis, being Th1-dominant, may improve during pregnancy due to the Th2 shift, potentially followed by a postpartum flare. The case study illustrates this pattern, with the patient experiencing relative stability during pregnancy but developing a significant relapse at 5 months postpartum. This relapse presented with right-sided numbness, right eye pain, and a new left pontine infarct on MRI, necessitating a restart of high-dose prednisone. Long-term management challenges included balancing disease control with the patient's desire for a second pregnancy. After comprehensive counseling on progression risks and treatment options, a shared decision-making process led to a combination therapy of prednisone and azathioprine, with potential transition to infliximab if needed. Conception for a second planned pregnancy was postponed for at least 6 months to allow for disease stabilization and establishment of an effective, pregnancy-compatible treatment regimen.

Conclusions Management of neurosarcoidosis in pregnancy requires a carefully tailored, multidisciplinary approach. Understanding the interplay between pregnancy-induced immunological changes and neurosarcoidosis is crucial for optimizing outcomes. This case study provides unique insights into managing this rare condition across different life stages, emphasizing the need for individualized treatment plans and close monitoring, particularly in the postpartum period.

Authors/Disclosures
Ashish D. Patel, MD (Geisinger) PRESENTER	An immediate family member of Dr. Patel has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Patel has stock in Ocular Therapeutix. Dr. Patel has stock in Autolus Therapeutics . Dr. Patel has stock in Larimar Therapeutics. Dr. Patel has stock in Viking Therapeutics. An immediate family member of Dr. Patel has stock in Voyager Therapeutics. An immediate family member of Dr. Patel has stock in BridgeBio Pharma, Inc.. An immediate family member of Dr. Patel has stock in Stoke Therapeutics. The institution of an immediate family member of Dr. Patel has received research support from The Patient-Centered Outcomes Research Institute.
Megan E. Esch, MD (Geisinger Medical Center)	The institution of Dr. Esch has received research support from PCORI.

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