Improvement with Infliximab of a Disseminated Sarcoidosis in a Patient with Crohn’s Disease

Sarcoidosis and Crohn’s disease are systemic granulomatous disorders affecting the lung and the intestine, respectively, with variable involvement of other organs and are seldom associated. While anti-TNFα is a recognized treatment of Crohn’s disease, its usage is discussed in sarcoidosis. A 42-year-old man presented with an 11-year-long history of Crohn’s disease; upon discovery of an abnormal chest CT scan the diagnosis of multivisceral sarcoidosis was made and, later, a treatment with an anti-TNFα agent, infliximab, was started, because of worsening Crohn’s disease recurrences. CT scan demonstrated net regression of pulmonary opacities and hepatosplenic lesions. Pathologies obtained from the intestinal tract and the bronchi of the patient were, respectively, characteristic of Crohn’s disease and sarcoidosis leading to the diagnosis of both diseases. We report a rare case of steroid resistant Crohn’s disease associated with multivisceral sarcoidosis, treated successfully by an anti-TNFα agent, infliximab. 1. Introduction Both sarcoidosis and Crohn’s disease are relapsing chronic inflammatory disorders characterized by the formation of granulomas; they share some organ locations, cytokine pathways, and genetic background. The association of both diseases has rarely been reported. If anti-TNFα is a recognized treatment of Crohn’s disease, its role in sarcoidosis remains discussed. We report the association of both diseases in a single patient and the beneficial effect of anti-TNFα on both diseases. 2. Case Report A 42-year-old man presented with a 3-month history of respiratory symptoms combining mild dyspnea, cough, asthenia, and weight loss. His past medical history included a 6-pack-year smoking habit and an 11-year-long history of Crohn’s disease, treated with oral steroids (prednisolone 20？mg/day) ever since. Over time, repeated biopsies showing ulceration and transmural inflammatory lesions of the ileum, the colon, and the rectum including submucosal aggregates of lymphocytes and plasmocytes and, once, rectal epithelioid granulomas were always consistent with the diagnosis. Physical exam showed no abnormalities. Peripheral blood lymphocyte count was decreased (890/μL including 374 CD4 lymphocytes/μL, i.e., 42%); serum angiotensin converting-enzyme level was elevated (118？U/L). CT scan was markedly abnormal (Figures 1(a), 1(b), and 1(c)) showing enlarged bilateral hilar and mediastinal lymph nodes, a left apical irregular nodule, bilateral perihilar infiltrates, upper lobe micronodules, proximal bronchial thickening, and hepatic and splenic