{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T05:01:05Z","timestamp":1780290065308,"version":"3.54.0"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tumor necrosis factor-\u03b1 (TNF-\u03b1) inhibitors such as infliximab are widely used in autoimmune disorders. Paradoxical inflammatory reactions including systemic sarcoidosis and neurosarcoidosis are increasingly recognized but remain rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a 56-year-old male with ulcerative colitis under infliximab therapy presenting with acute dysarthria and gait instability. Neurological examination revealed truncal ataxia. Brain and spinal MRI were normal. Cerebrospinal fluid analysis showed lymphocytic pleocytosis, reduced glucose, increased lactate, and elevated protein with marked blood-brain barrier disruption. Sarcoidosis-associated markers (neopterin, ACE, IL-2 receptor) were elevated. Pulmonary CT and lymph node biopsy confirmed systemic sarcoidosis. Moreover, MOG-antibodies were detected in both serum and CSF. After initial empirical anti-infective therapy, high-dose corticosteroids were initiated, resulting in full recovery. Infliximab therapy was discontinued.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case demonstrates infliximab-associated overlapping autoimmunity with sarcoidosis, probable neurosarcoidosis and MOGAD presenting with acute cerebellitis. Clinicians should consider neurosarcoidosis and MOGAD in patients on TNF-\u03b1-inhibitors presenting with neurological deficits, even in the absence of radiological findings. Early discontinuation of the triggering agent and timely corticosteroid therapy are essential for favorable outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1759831","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T04:18:10Z","timestamp":1780287490000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Severe cerebellitis as a manifestation of infliximab-associated overlap of neurosarcoidosis and myelin oligodendrocyte glycoprotein antibody-associated disease \u2013 case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Gregor","family":"H\u00fctter","sequence":"first","affiliation":[{"name":"Department of Neurology, St. Josef-Hospital","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Winkelhausen","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Josef-Hospital","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"T\u00f6nges","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Josef-Hospital","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Gold","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Josef-Hospital","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Faissner","sequence":"additional","affiliation":[{"name":"Department of Neurology, St. Josef-Hospital","place":["Bochum, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"27192021","DOI":"10.3390\/ijms22052719","article-title":"The role of tumor necrosis factor alpha (TNF-\u03b1) in autoimmune disease and current TNF-\u03b1 inhibitors in therapeutics","volume":"22","author":"Jang","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B2","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1007\/s10072-026-08955-z","article-title":"Neurosarcoidosis-like reaction under TNF-\u03b1 inhibitors: a case report and literature review of a paradoxical immune phenomenon","volume":"47","author":"Barbella","year":"2026","journal-title":"Neurological Sciences: Off J Ital Neurological Soc Ital Soc Clin Neurophysiol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2008.11.003","article-title":"Sarcoidosis appearing during anti-tumor necrosis factor alpha therapy: a new \"class effect\" paradoxical phenomenon. Two case reports and literature review","volume":"39","author":"Massara","year":"2010","journal-title":"Semin Arthritis Rheum"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e1084","DOI":"10.1212\/NXI.0000000000001084","article-title":"Neurosarcoidosis: pathophysiology, diagnosis, and treatment","volume":"8","author":"Bradshaw","year":"2021","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2018.2295","article-title":"Definition and consensus diagnostic criteria for neurosarcoidosis: from the Neurosarcoidosis Consortium Consensus Group","volume":"75","author":"Stern","year":"2018","journal-title":"JAMA Neurol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000005725","article-title":"Infliximab for the treatment of CNS sarcoidosis: a multi-institutional series","volume":"89","author":"Gelfand","year":"2017","journal-title":"Neurology"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e847","DOI":"10.1212\/nxi.0000000000000847","article-title":"Infliximab treatment in pathology-confirmed neurosarcoidosis","volume":"7","author":"Fritz","year":"2020","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.51968","article-title":"Infliximab in neurosarcoidosis: a systematic review and meta-analysis","volume":"11","author":"Chaiyanarm","year":"2024","journal-title":"Ann Clin Transl Neurol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-007-0272-7","article-title":"Neurosarcoidosis presenting as a cerebellar mass","volume":"22","author":"Kumar","year":"2007","journal-title":"J Gen Intern Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.0784-22","article-title":"Immune-mediated cerebellar ataxia with neurosarcoidosis","volume":"62","author":"Mizushima","year":"2023","journal-title":"Intern Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1007\/s11910-017-0742-1","article-title":"CNS demyelination with TNF-\u03b1 blockers","volume":"17","author":"Kemanetzoglou","year":"2017","journal-title":"Curr Neurol Neurosci Rep"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1212\/nxi.0000000000000205","article-title":"Autopsy-proven demyelination associated with infliximab treatment","volume":"3","author":"Bradshaw","year":"2016","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(22)00431-8","article-title":"Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria","volume":"22","author":"Banwell","year":"2023","journal-title":"Lancet Neurol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-026-07976-5","article-title":"Overlapping autoimmunity and demyelination syndromes associated with TNF inhibitor therapy","volume":"45","author":"Daood","year":"2026","journal-title":"Clin Rheumatol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2025.109111","article-title":"Repeated MRI-negative demyelinating attacks linked to MOG-IgG antibodies and silent lesions - case series and literature review","volume":"257","author":"Friedman-Korn","year":"2025","journal-title":"Clin Neurol Neurosurg"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1759831\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T04:18:10Z","timestamp":1780287490000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1759831\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":15,"alternative-id":["10.3389\/fimmu.2026.1759831"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1759831","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]},"article-number":"1759831"}}