Abstract
IntroductionSarcoidosis is an inflammatory disorder characterized by the presence of non-caseating granulomas in affected organs. The presence of CD4-positive T lymphocytes and macrophages in affected organs suggests an ongoing immune response. Systemic corticosteroids remain the mainstay of treatment, but therapy is often limited by adverse effects. This is the first report of the use of adalimumab (HUMIRA®, Abbott Laboratories, North Chicago, IL, USA), an anti-tumor necrosis factor monoclonal antibody, in a patient with systemic sarcoidosis with bone marrow involvement.Case presentationA 42-year-old African-American man with a medical history significant for hypertension and diabetes mellitus presented with anemia and thrombocytopenia of two months duration. The patient underwent physical examination, bone marrow aspiration and biopsy, chest X-ray, acid-fast bacilli stain, computed tomography with contrast, and additional laboratory tests. He was diagnosed with systemic sarcoidosis with splenomegaly and bone marrow involvement. Drug therapy included prednisone, which had to be discontinued owing to adverse effects, and adalimumab.ConclusionThis is the first report describing the use of adalimumab in a patient with systemic sarcoidosis with bone marrow involvement. Tumor necrosis factor antagonism with adalimumab was efficacious and well-tolerated in this patient and may be considered as a treatment option for similar cases.
Highlights
Introduction: Sarcoidosis is an inflammatory disorder characterized by the presence of noncaseating granulomas in affected organs
This is the first report of the use of adalimumab (HUMIRA®, Abbott Laboratories, North Chicago, IL, USA), an antitumor necrosis factor monoclonal antibody, in a patient with systemic sarcoidosis with bone marrow involvement
This is the first report describing the use of adalimumab in a patient with systemic sarcoidosis with bone marrow involvement
Summary
Sarcoidosis is an inflammatory disorder characterized by the presence of non-caseating granulomas in affected organs [1]. Two weeks after adalimumab was initiated, the patient’s anemia was markedly improved, as evidenced by an elevation in hemoglobin concentration to 5.96 mmol/L (Table 1). 8 months post-diagnosis, it was discovered that the patient had discontinued adalimumab 9 weeks previously; the patient said he thought he was supposed to stop the medication His hemoglobin concentration had decreased to 4.41 mmol/L. The hemoglobin concentration continued to decrease over the 5 weeks (Table 1), but after approximately five doses of the second course of adalimumab, his hemoglobin concentration increased to 4.47 mmol/L and his anemia continued to improve over the several months. By the 49th week post-diagnosis, the patient’s spleen was no longer palpable and a chest X-ray was negative His initial weight loss was completely resolved. Follow-up CT scans revealed marked decreases in spleen size post-diagnosis; spleen size was 13 × 6.4 cm 18 months after the first CT scan and 11.6 × 5.6 cm 25 months after the first CT scan
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