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Refractory multisystem sarcoidosis responding to infliximab therapy

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Abstract

Chronic progressive multisystem granulomatous disease is seen in 10–30% of patients with sarcoidosis and can result in end organ damage. Corticosteroids are the mainstay of treatment with the addition of cytotoxic agents in severe cases. Some patients are refractory to such treatment and, therefore, management is a challenge. There is currently limited evidence for biological agents such as infliximab, a monoclonal anti-tumor necrosis factor-α antibody in the treatment of multisystem sarcoidosis. We report outcomes of three patients with extensive multisystem sarcoidosis refractory to conventional treatment and treated at our center. Clinical assessment and radiographic imaging were used to assess the response to infliximab treatment. Infliximab therapy induced clinical remission in all three patients, and this clinical response correlated with radiographic evidence of the resolution of granulomatous disease. Serum ACE level was reduced in all cases, and daily steroid dosage was reduced. We propose that infliximab can be an effective treatment in patients with multisystem complex sarcoidosis refractory to conventional drug therapy and can result in sustained clinical remission. Our experience supports the urgent need for randomized controlled clinical trials of anti-TNF therapy in refractory systemic sarcoidosis.

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Patient consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

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Authors and Affiliations

  1. Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Dudley Road, Birmingham, B18 7QH, UK

    Adam P. Croft, Deva Situnayake, Omer Khair, David Carruthers, Arul Sivaguru & Caroline Gordon

  2. School of Infection and Immunity, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK

    Adam P. Croft & Caroline Gordon

  3. Queen Mary University of London, Centre for Neuroscience and Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK

    Gavin Giovanni

Authors
  1. Adam P. Croft
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  2. Deva Situnayake
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  3. Omer Khair
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  4. Gavin Giovanni
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  5. David Carruthers
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  6. Arul Sivaguru
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  7. Caroline Gordon
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Corresponding author

Correspondence to Caroline Gordon.

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Croft, A.P., Situnayake, D., Khair, O. et al. Refractory multisystem sarcoidosis responding to infliximab therapy. Clin Rheumatol 31, 1013–1018 (2012). https://doi.org/10.1007/s10067-011-1933-9

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  • DOI: https://doi.org/10.1007/s10067-011-1933-9

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