Treatment of complicated sarcoidosis with infliximab anti-tumor necrosis factor-alpha therapy

Background: Tumor necrosis factor-alpha (TNF-alpha) may have an important r ole in the clinical exacerbation of sarcoidosis. Objective: To treat sarcoidosis with infliximab, a chimeric human-murine an ti-human TNF-alpha monoclonal antibody. Design: Case report. Setting: U.S. academic medical center. Patient: A 72-year-old woman with sarcoidosis presenting with severe protei n-losing enteropathy, hypoalbuminemia, and proximal myopathy who had not re sponded adequately to corticosteroid therapy and whose clinical course was further complicated by acute tubular necrosis and renal failure requiring l ong-term hemodialysis. Intervention: Intravenous infusion of infliximab, 5 mg/kg of ideal body wei ght; 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 ther apy, and the serum albumin level also improved. However, the clinical cours e 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 sarcoidosi s. Tumor necrosis factor-a may be an important mediator of clinical disease in sarcoidosis and could be an attractive target for therapeutic intervent ion. However, infliximab may cause adverse effects associated with cytokine cascade manipulation.