Refractory multisystem sarcoidosis responding to infliximab therapy

Area of Science:

• Immunology
• Pulmonology
• Rheumatology

Background:

• Sarcoidosis is a multisystem granulomatous disease affecting 10-30% of patients, potentially leading to organ damage.
• Conventional treatments like corticosteroids and cytotoxic agents are not always effective, posing a management challenge for refractory cases.
• Limited evidence exists for biological agents, specifically infliximab (anti-tumor necrosis factor-α antibody), in treating multisystem sarcoidosis.

Observation:

• This study reports on three patients with extensive, treatment-refractory multisystem sarcoidosis.
• Patients received infliximab therapy at the center.
• Clinical assessment and radiographic imaging were used to evaluate treatment response.

Findings:

• Infliximab therapy induced clinical remission in all three patients.
• Radiographic imaging confirmed resolution of granulomatous disease, correlating with clinical response.
• Serum angiotensin-converting enzyme (ACE) levels decreased, and daily steroid dosage was reduced in all patients.

Implications:

• Infliximab may be an effective treatment for multisystem sarcoidosis refractory to conventional therapies, potentially leading to sustained clinical remission.
• These findings support the need for rigorous clinical trials to evaluate anti-tumor necrosis factor-α therapy in refractory systemic sarcoidosis.
• Further research, including randomized controlled trials, is crucial to establish the role of infliximab in managing complex sarcoidosis cases.