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Colonic Sarcoidosis, Infliximab, and Tuberculosis: A Cautionary Tale

Sorrentino, Dario MD; Avellini, Claudio MD*; Zearo, Ester MD

Case Reports

The antitumor necrosis factor, infliximab, has been recently shown to be effective in refractory sarcoidosis including the intestinal form of this disease. We have tried this therapy in a 55-year-old woman under immunosuppressive therapy for longstanding sarcoidosis presenting with abdominal pain apparently caused by a colonic localization of the disease. The latter diagnosis was based, as recommended, on the presence of nonnecrotizing granulomas in mucosal biopsies, the presence of systemic disease, and the careful exclusion of other granulomatous diseases, including tuberculosis. After the first IV infusion (10 mg/kg BW), she quickly improved, but the wellbeing lasted approximately 4 weeks. She then received another dose of infliximab, but she soon developed low-grade fever and weakness and shortly succumbed of miliary tuberculosis. Likely, infliximab precipitated a pre-existing mycobacterial infection of the intestine. Given the likelihood of underdiagnosing intestinal tuberculosis—and the risks associated with infliximab treatment—this case suggests that this drug should be used with extreme caution, if at all, when a diagnosis of colonic sarcoidosis is suspected.

From the G. I. Unit–Internal Medicine of the Department of Clinical and Experimental Pathology and *Department of Pathology, University of Udine School of Medicine, Udine, Italy.

Received for publication December 4, 2003; accepted January 14, 2004.

Reprints: Prof. Dario Sorrentino, Medicina Interna Policlinico, Universitario P.zza SMM 1 33100 Udine – Italy (e-mail: Sorrentino@uniud.it).

© Crohn's & Colitis Foundation of America, Inc.
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