Successful steroid-sparing treatment of renal limited sarcoidosis with mycophenolate mofetil

Abstract

Sarcoidosis is a multi-system disorder characterized by non-caseating epithelioid granulomas in multiple organs. The disease usually presents in young adults and is uncommon in children. Renal involvement can usually occur due to granulomatous interstitial nephritis, but renal failure is uncommon. Corticosteroids are the mainstay of therapy. We present the report of a child with severe renal failure secondary to renal limited sarcoidosis who was successfully treated with corticosteroid induction therapy. Because of the severe side effects of corticosteroids, mycophenolate mofetil was added and corticosteroids were tapered off. The child has been in sustained remission for over a year with mycophenolate mofetil monotherapy.

Mizoribine for renal sarcoidosis: effective steroid tapering and prevention of recurrence

“…b Non-caseating epithelioid granulomas (arrow). Hematoxylin-eosin stain, magnification ×400 sive agents, such as cyclosporine [5], chloroquine [6,7], methotrexate [6,11], mycophenolate mofetil (MMF) [12][13][14], cyclophosphamide [15], and tumor necrosis factor blockade [10,16], have been reported to be effective in preventing the recurrence during the tapering of steroids; MZR has been shown to be effective in this regard. To our knowledge, this is the first report of the clinical benefit of MZR in renal sarcoidosis.…”

Renal Transplantation in Patients with Sarcoidosis

“…Steroids have been effectively used as a first-line therapy for sarcoidosis, first relapse, or renal graft recurrence (5,10,26 -30). Also, mycophenolate mofetil has been used as steroid-sparing agent in cases of steroid-dependent sarcoidosis (37)(38)(39)(40)(41). Sarcoidosis is associated with an increase in peripheral regulatory T lymphocytes (Treg) cells, accounting for the anergic state usually observed in these patients; however, these levels are still unable to control local inflammation and granuloma formation (42).…”

Medicines used in respiratory diseases only seen in children

“…Hydroxychloroquine therapy has been used with success in two Australian male children with diffuse pulmonary sarcoidosis [265]. Successful steroid-sparing treatment of severe renal failure secondary to limited renal sarcoidosis was reported in a child treated with mycophenolate mofetil [266]. Anti-TNF-a strategies have also been used in children with sarcoidosis [267,268].…”