Infliximab Treatment of Refractory Cardiac Sarcoidosis

Majid Asawaeer; Benjamin Widener; Varda Singhal; Matthew J DeVries; Debra J Romberger; Alan R Erickson; Yiannis S Chatzizisis

doi:10.1016/j.jaccas.2020.06.041

Infliximab Treatment of Refractory Cardiac Sarcoidosis

JACC Case Rep. 2020 Aug 19;2(10):1553-1557. doi: 10.1016/j.jaccas.2020.06.041. eCollection 2020 Aug.

Authors

Majid Asawaeer¹, Benjamin Widener², Varda Singhal¹, Matthew J DeVries³, Debra J Romberger⁴, Alan R Erickson², Yiannis S Chatzizisis¹

Affiliations

¹ Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
² Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska.
³ Division of Radiology, University of Nebraska Medical Center, Omaha, Nebraska.
⁴ Division of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska.

Abstract

Treatment of cardiac sarcoidosis is challenging, as the disease can be refractory to traditional treatment with steroids. Infliximab, a tumor necrosis factor-α inhibitor, has been reportedly used in cardiac sarcoidosis, but published evidence is limited. The potential cardiotoxicity of infliximab and the Food and Drug Administration black-box warning for patients with heart failure have hindered the use of this agent in cardiac sarcoidosis. Here, we report a case of refractory cardiac sarcoidosis successfully treated with infliximab and discuss the important role of fluorine-18-fluorodeoxyglucose positron emission tomography in prognostication and guidance of therapy. (Level of Difficulty: Intermediate.).

Keywords: 18F-FDG, fluorine-18–fluorodeoxyglucose; CMR, cardiac magnetic resonance; CS, cardiac sarcoidosis; PET, positron emission tomography; TNF, tumor necrosis factor; cardiac sarcoidosis; infliximab; magnetic resonance imaging; positron emission tomography.

Publication types

Case Reports