Abstract
Background Chronic progressive multisystem granulomatous disease is seen in 10–30% of patients with sarcoidosis and can result in end organ damage [1]. Corticosteroids are the mainstay of treatment with the addition of cytotoxic agents in severe cases. Some patients are refractory to such treatment and therefore management is a challenge. There is currently limited evidence for biological agents such as infliximab, a monoclonal anti-tumor necrosis factor-a antibody in the treatment of multisystem sarcoidosis. Aim of this case report is to disseminate knowledge concerning successful treatment of multisystem sarcoidosis involving pelvis with the use of TNF-a blockers in refractory cases.
Highlights
Chronic progressive multisystem granulomatous disease is seen in 10–30% of patients with sarcoidosis and can result in end organ damage [1]
On literature review there are reported case of vertebral sarcoidosis treated with anti TNF
Treatment Intavenous zolendronic acid helped with bone pain and hypercalcemia
Summary
Chronic progressive multisystem granulomatous disease is seen in 10–30% of patients with sarcoidosis and can result in end organ damage [1]. There is currently limited evidence for biological agents such as infliximab, a monoclonal anti-tumor necrosis factor-a antibody in the treatment of multisystem sarcoidosis. Case presentation 33 yr old lady referred to Rheumatology with arthralgia, myalgia, malaise, headaches, facial swelling, nausea, vomiting, ear and neck pain and tingling in her fingers Serum ACE levels were elevated and lymphnode biopsy confirmed Sarcoidosis She was started on oral prednisolone 40mg daily with good response. She developed erythema nodosum, relapse of uveitis and repeated episodes of hypercalcemia needing hospital admission on trying to reduce the dose of steroids. Continued to have active disease and started on infliximab and methotrexate She improved on this combination treatment and managed to reduce steroids gradually. She is on this treatment for a year and the condition is well controlled
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