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.