Treatment of Complicated Sarcoidosis with Infliximab Anti–Tumor Necrosis Factor-α Therapy

  1. Arthur M.F. Yee, MD, PhD; and
  2. Mark B. Pochapin, MD
  1. From Hospital for Special Surgery and New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York.

    Abstract

    Background: Tumor necrosis factor-α (TNF-α) may have an important role in the clinical exacerbation of sarcoidosis.

    Objective: To treat sarcoidosis with infliximab, a chimeric human–murine anti–human TNF-α monoclonal antibody.

    Design: Case report.

    Setting: U.S. academic medical center.

    Patient: A 72-year-old woman with sarcoidosis presenting with severe protein-losing enteropathy, hypoalbuminemia, and proximal myopathy who had not responded adequately to corticosteroid therapy and whose clinical course was further complicated by acute tubular necrosis and renal failure requiring long-term hemodialysis.

    Intervention: Intravenous infusion of infliximab, 5 mg/kg of ideal body weight; infusion was repeated at 2 and 6 weeks.

    Measurements: Clinical response of enteropathic and myopathic symptoms and serum albumin level.

    Results: Enteropathic and myopathic symptoms resolved after infliximab therapy, and the serum albumin level also improved. However, the clinical course was complicated by the development of a hypercoagulable state associated with circulating anticardiolipin antibodies, which prompted discontinuation of infliximab therapy.

    Conclusions: Infliximab therapy was successful in a patient with sarcoidosis. Tumor necrosis factor-α may be an important mediator of clinical disease in sarcoidosis and could be an attractive target for therapeutic intervention. However, infliximab may cause adverse effects associated with cytokine cascade manipulation.

    Article and Author Information

    • Acknowledgments: The authors thank Drs. Flavia A. Golden, Stephen A. Paget, and Lionel B. Ivashkiv for critical reading of the manuscript.

    • Requests for Single Reprints: Arthur M.F. Yee, MD, PhD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.

    • Current Author Addresses: Dr. Yee: Division of Rheumatic Diseases, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021.

    • Dr. Pochapin: Division of Digestive Diseases, New York Presbyterian Hospital, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021.

    • Author Contributions: Conception and design: A.M.F. Yee.

    • Analysis and interpretation of the data: A.M.F. Yee, M.B. Pochapin.

    • Drafting of the article: A.M.F. Yee.

    • Critical revision of the article for important intellectual content: A.M.F. Yee, M.B. Pochapin.

    • Final approval of the article: A.M.F. Yee, M.B. Pochapin.

    • Provision of study materials or patients: A.M.F. Yee, M.B. Pochapin.

    • Administrative, technical, or logistic support: A.M.F. Yee.

    • Collection and assembly of data: A.M.F. Yee, M.B. Pochapin.

    Summary for Patients

    • Summaries for Patients:A New Anti-Inflammatory Therapy (Infliximab) for Complicated Sarcoidosis Ann Intern Med July 3, 2001 135:S20
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    1. Ann Intern Med July 3, 2001 vol. 135 no. 1 27-31
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