Abstract Introduction We present a 65-year-old never-smoker male with chronic, refractory multi-system sarcoidosis—a rare and diagnostically challenging condition. Over a decade, he developed persistent, treatment-resistant involvement of the lungs (stage I), eyes (panuveitis), sinonasal tract, peripheral nerves, and heart (cardiac sarcoidosis requiring BiV-ICD placement). Despite extensive immunosuppression and multimodal pain management, he continues to experience debilitating neuropathic pain, myoclonic jerks, and chronic fatigue. Refractory sarcoidosis, especially with cardiac, neurologic, and ocular manifestations, carries high morbidity, and chronic fatigue and neuropathic symptoms significantly impair quality of life. Case Summary (Timeline-Based) 2015-2016 (Age 54-56): Initial presentation with stage I pulmonary sarcoidosis, panuveitis, chronic sinonasal disease, and peripheral neuropathy. Immunosuppression included Prednisone 10 mg daily, Imuran 100 mg daily, IVIG 100-200 gm every 2-4 weeks, and Remicade 450 mg every 4 weeks. Neuropathic pain was managed with Oxycontin and Norco; fatigue with Focalin and Provigil. Ophthalmology noted resolution of uveitis after flares. Despite therapy, myoclonic jerks and neuropathic pain persisted.2018-2019 (Age 58-59): Rituximab 2 gm every 6 months was initiated for persistent inflammatory neuropathy and fatigue, producing transient improvement. IVIG dose adjusted to 70 gm every 10 days. Pulmonary and ocular disease remained stable. Pain management included Oxycontin, Norco, and medical marijuana. Myoclonic jerks persisted despite 3 mg BID Klonopin.2020-2021 (Age 60-62): Developed cardiac sarcoidosis with symptomatic bradycardia; underwent BiV-ICD placement in 2021. Immunosuppressive therapy included Prednisone 10 mg daily, Imuran 150 mg daily, IVIG 70 gm every 10 days, and Infliximab 750 mg monthly. Neuropathic symptoms partially controlled; RFA for lumbar nerves improved chronic pain. Ophthalmology confirmed stable eyes; no new pulmonary or sinonasal flares.2023-2025 (Age 63-65): Persistent pain, myoclonic jerks, and fatigue managed with multimodal therapy: Oxycontin 40 mg BID, Norco PRN, medical marijuana, RFA, Klonopin, Baclofen, Skelaxin, Focalin, and Provigil. Pulmonary, ocular, sinonasal, and cardiac disease remained stable. Weight loss of 40-60 lbs improved overall health and gastroparesis symptoms. Patient is fully disabled due to persistent disease burden despite optimized therapy. Conclusion This case exemplifies the complexity of refractory, multi-system sarcoidosis with overlapping stiff-person syndrome. Long-term, individualized management with immunosuppressive therapy, cardiac monitoring, neurologic care, and multimodal pain control is essential. The case highlights the unmet need for novel therapeutic strategies and multidisciplinary care in patients with refractory sarcoidosis, chronic neuropathic pain, and fatigue. This abstract is funded by: None
Abushamma et al. (Fri,) studied this question.