Life-threatening multisystem sarcoidosis with neurological, renal, ocular and autoimmune haemolytic manifestations treated with intravenous immunoglobulin, plasma exchange, cyclophosphamide and infliximab.

Multisystem sarcoidosis is uncommon and presentation as a stroke mimic with severe renal impairment and concurrent haemolysis has not previously been described. Evidence for the use of plasma exchange (PLEX) in sarcoidosis is limited. This case describes a patient with multisystem sarcoidosis who presented with encephalopathy, acute tubulointerstitial nephritis, optic neuritis and autoimmune haemolytic anaemia. Extensive immunological investigations were non-diagnostic. The patient's neurological and haematological manifestations improved rapidly with intravenous methylprednisolone, intravenous immunoglobulin and PLEX. Her clinical course was complicated by sight-threatening steroid-induced glaucoma, adrenocortical insufficiency and diabetes mellitus. Her extra-ocular, extra-renal manifestations responded to oral glucocorticoid and intravenous cyclophosphamide therapy, while complete remission of ocular and renal disease was achieved with infliximab therapy at 12 and 24 months, respectively.