Colonic sarcoidosis, infliximab, and tuberculosis: a cautionary tale.
The antitumor necrosis factor, infliximab, has been recently shown to be effective in refractory sarcoidosis including the intestinal form of this disease. We have tried this therapy in a 55-year-old woman under immunosuppressive therapy for longstanding sarcoidosis presenting with abdominal pain apparently caused by a colonic localization of the disease. The latter diagnosis was based, as recommended, on the presence of nonnecrotizing granulomas in mucosal biopsies, the presence of systemic disease, and the careful exclusion of other granulomatous diseases, including tuberculosis. After the first IV infusion (10 mg/kg BW), she quickly improved, but the wellbeing lasted approximately 4 weeks. She then received another dose of infliximab, but she soon developed low-grade fever and weakness and shortly succumbed of miliary tuberculosis. Likely, infliximab precipitated a pre-existing mycobacterial infection of the intestine. Given the likelihood of underdiagnosing intestinal tuberculosis--and the risks associated with infliximab treatment--this case suggests that this drug should be used with extreme caution, if at all, when a diagnosis of colonic sarcoidosis is suspected.
Department of Clinical and Experimental Pathology, University of Udine School of Medicine, Udine, Italy. Sorrentino@uniud.it
Dario
D
Sorrentino
Claudio
C
Avellini
Ester
E
Zearo
D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003108:Colonic Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D017809:Fatal Outcome; D005260:Female; D006099:Granuloma / Q000473:pathology; D006801:Humans; D000069285:Infliximab; D008875:Middle Aged; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy*; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000473:pathology*; D014409:Tumor Necrosis Factor-alpha
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab