Infliximab-Induced Pneumonitis in a Patient With Sarcoidosis: A Case Report

Infliximab, a tumor necrosis factor alpha (TNF-α) inhibitor, is recommended in selected cases of pulmonary sarcoidosis. Although infectious complications are well recognized, non-infectious pulmonary toxicity is less frequently reported. We describe the case of a 52-year-old woman with atypical alveolar sarcoidosis who developed acute pneumonitis after initiation of infliximab. The patient had persistent disease despite treatment with systemic corticosteroids and methotrexate and was started on infliximab. Following the second dose, she presented with acute worsening dyspnea, tachycardia, and desaturation. High-resolution computed tomography revealed bilateral mosaic attenuation and ground-glass nodules. An infectious cause was excluded, and the temporal relationship with infliximab exposure supported the diagnosis of infliximab-induced pneumonitis. Treatment with high-dose systemic corticosteroids led to clinical and radiological improvement, and infliximab was permanently discontinued. To our knowledge, this is the first reported case of infliximab-induced pneumonitis in the specific setting of pulmonary sarcoidosis.