Treatment of complicated sarcoidosis with infliximab anti-tumor necrosis factor-alpha therapy.
BACKGROUND
Tumor necrosis factor-alpha (TNF-alpha) may have an important role in the clinical exacerbation of sarcoidosis.


OBJECTIVE
To treat sarcoidosis with infliximab, a chimeric human-murine anti-human TNF-alpha monoclonal antibody.


METHODS
Case report.


METHODS
U.S. academic medical center.


METHODS
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.


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


METHODS
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-alpha 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.
Yee
A M
AM
Hospital for Special Surgery and New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
Pochapin
M B
MB
D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D000069285:Infliximab; D007683:Kidney Tubular Necrosis, Acute / Q000150:complications; D008171:Lung Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D018908:Muscle Weakness / Q000150:complications / Q000188:drug therapy; D011504:Protein-Losing Enteropathies / Q000150:complications / Q000188:drug therapy; D006435:Renal Dialysis; D012507:Sarcoidosis / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D012709:Serum Albumin / Q000378:metabolism; D013927:Thrombosis / Q000139:chemically induced; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab