Cureus. 2026 Sep 24;18(9):e116827. doi: 10.7759/cureus.116827. eCollection 2026 Sep.
ABSTRACT
Glucocorticoids remain the first-line treatment for pulmonary and extrapulmonary sarcoidosis, with anti-tumor necrosis factor-alpha (TNF-α) agents such as infliximab typically reserved as steroid-sparing alternatives or for refractory disease. Data on anti-TNF-α monotherapy as first-line treatment, avoiding glucocorticoid exposure altogether, remain limited to isolated case reports. We report the case of a 46-year-old obese man with hypertension and dyslipidemia who presented with hepatic, splenic, and pulmonary sarcoidosis. Given his cardiometabolic risk profile, glucocorticoids were avoided entirely, and infliximab monotherapy was initiated as first-line treatment, resulting in marked clinical and radiological improvement within seven months. This case suggests that infliximab monotherapy may represent a safe and effective first-line alternative to glucocorticoids in selected patients with multiorgan sarcoidosis and significant cardiometabolic comorbidity.
PMID:42927362 | PMC:PMC13695320 | DOI:10.7759/cureus.116827