Isolated renal sarcoidosis: a rare presentation of a rare disease treated with infliximab

Abstract

Sarcoidosis is a multisystem disease characterized by noncaseating granulomatous reaction frequently involving the lymph nodes, lungs, liver, skin, and eyes. Acute renal failure (ARF) as an isolated manifestation of sarcoidosis is rare. We describe a case of sarcoidosis presenting as transient polyarthritis and ARF due to isolated granulomatous infiltration of the renal parenchyma. Renal biopsy showed granulomatous interstitial nephritis with noncaseating granulomas consistent with sarcoidosis. Bacterial, fungal, and mycobacterial infections were excluded. There was no evidence of extrarenal sarcoid involvement. Prednisone of 60 mg daily resulted in significant improvement in renal function. Because of recurrent flares on steroid taper and steroid toxicity, treatment with infliximab, an anti-tumor necrosis factor-alpha (TNF-alpha) antibody, was instituted and resulted in stabilization of renal function despite steroid taper. Although uncommon, renal sarcoidosis should be considered in the differential diagnosis of acute or chronic renal failure of uncertain etiology, as early diagnosis and treatment can lead to recovery of renal function and prevent interstitial fibrosis. Corticosteroids are mainstay of therapy. Steroid-dependent or refractory cases may respond to other immunosuppressants including anti-TNF-alpha agents.

Genitourinary sarcoidosis: An essential review for the practicing clinician

“…[34] Infliximab may be effective in relapsing or steroid-resistant patients. [35] in very carefully selected cases, renal transplantation may be appropriate. Sarcoidosis may appear in the allografted organ.…”

Drug-Induced Granulomatous Interstitial Nephritis in a Patient With Ankylosing Spondylitis During Therapy With Adalimumab

“…Furthermore, infliximab has been used with success to treat renal sarcoid. 35 Another approach would have been to rechallenge our patient with adalimumab, as reported by others, 36 or switch treatment to etanercept, which is a fusion protein of soluble TNF receptor and human IgG. However, there is evidence that etanercept is not effective in the treatment of sarcoidosis.…”

A Case Series of Refractory Cutaneous Sarcoidosis Successfully Treated with Infliximab

“…Although there have been no comparative trials between the biologic agents for sarcoidosis, infliximab is the most heavily reported medication in the literature [6–11], and overall has shown great promise in the treatment of sarcoidosis patients refractory to more conventional therapies [6, 7, 12, 26]. Favorable outcomes of infliximab therapy in patients who have renal sarcoidosis [13], vertebral sarcoidosis [14], joint sarcoidosis [15], optic neuropathy [16], pulmonary sarcoidosis [6, 17], retinal vasculitis [18], cutaneous sarcoidosis [3–5, 22], neurosarcoidosis [19], and cardiac sarcoidosis [20] have also been reported.…”