Objective:

To investigate outcomes of coronavirus disease 2019 (COVID-19) in neurosarcoidosis (NS).

Background:

A prior study investigating COVID-19 outcomes in systemic sarcoidosis has identified patients with neurologic involvement to be at increased risk for COVID-19 complications. Questions remain regarding what features of neurosarcoidosis predispose to a more severe COVID-19 course.

Design/Methods:

Patients diagnosed with neurosarcoidosis were included if the electronic medical record indicated the patient had been infected with COVID-19.

Results:

Twenty-one patients with NS were included with a median age of 57 years (range 22-75) and median illness duration of 96 months (range 2-348) at the time of the COVID-19 infection. Eight (38.1%) had active-uncontrolled NS disease, five (23.8%) had active-controlled disease, and eight (38.1%) had inactive disease. 15/21 (71.4%) were on immunosuppressants, most commonly steroids (12, 57.1%), infliximab (9, 42.9%), and methotrexate (8, 38.1%). 10/21 (47.6%) had documented vaccination records against COVID-19 prior to the infection, while the remaining were un- or inadequately vaccinated. No adverse reactions to vaccinations were reported. Only one patient was asymptomatic of COVID-19. 7/20 (35.0%) patients (all immunosuppressed and 5 vaccinated) required hospital admission for a median of 7 days, including one unvaccinated patient (1/19, 5.3%) in a ventilated ICU setting. 8 patients (8/21, 38.1%) received anti-COVID treatments (remdesivir, monoclonal antibodies, or nirmatrelvir/ritonavir), all but one of which were immunosuppressed and five of which were vaccinated. Adjustments to immunosuppressants were made in 4 patients (4/21, 19.0%) during the active infection. 18/21 (85.7%) recovered completely from infection. One (1/21, 4.7%) patient died from COVID-19. 2/17 patients (11%) with follow-up data experienced clinical symptoms suggestive of NS relapse or progression within 90 days of infection.

Conclusions:

Most NS patients experienced symptomatic COVID-19 infection, including a higher rate of hospitalization than previously reported in the general population. Most patients experiencing severe disease were immunosuppressed and vaccinated.