Zahi Touma

Cardiac sarcoidosis responding to monotherapy with infliximab.

Cardiac involvement is a rare and potentially life-threatening complication of sarcoidosis. We report the case of a young previously healthy woman who presented with complete atrioventricular heart block. Further evaluation revealed non-caseating granulomas in the hilar and mediastinal regions. A pacemaker was inserted, and she was treated with four doses of infliximab after she refused treatment with steroids. Rapid resolution of the pulmonary lymph nodes was documented and repeated interrogations of the pacemaker 1xa0year after her last infliximab infusion documented that she was in sinus rhythm. Infliximab may be considered as an alternative first-line therapy in sarcoidosis with serious organ involvement.

The use of TNF-α blockers in Cogan’s syndrome

A 37-year-old woman, previously healthy, who in September 2001 noted sudden onset of erythema in both eyes, followed by vertigo, vomiting, tinnitus in both ears, and hearing loss in the left ear then in the right over 1-week period. Slit lamp examination revealed bilateral interstitial keratitis. Her physical examination was essentially unremarkable except for decreased hearing bilaterally, more so on the right. An audiogram conWrmed the presence of severe bilateral sensorineural hearing loss (SNHL), more so on the right. Brainstem auditory evoked response testing revealed delay of all waves on the left and no waves on the right. A gadolinium enhanced MRI of the brain conWrmed the presence of inXammation around the cochlea bilaterally. Her laboratory tests at that time showed a sedimentation rate of 26 mm/h, with a negative ANA, rheumatoid factor, anti-SSA and anti-SSB, anticardiolipins (IgG, IgM), c-ANCA and p-ANCA, and VDRL. A lumbar puncture was normal. Her chest X-ray, electrocardiogram and echocardiography were also normal. Accordingly, the diagnosis of Cogan’s syndrome was made. Therapy was initiated with topical steroid eye drops and oral prednisone at 1 mg/kg/day. The ocular symptoms improved within few days but after 3 weeks, the patient denied any clinical improvement in her hearing and audiogram conWrmed worsening of the SNHL on the left. After 3 weeks from the diagnosis of Cogan’s syndrome the Wrst dose of inXiximab was initiated at 3 mg/kg for three doses at 0, 2 and 6 weeks. After the Wrst dose of inXiximab, the patient reported decrease in the sensation of aural fullness and vertigo and subjective improvement in hearing, associated with improvement on the audiogram in the left ear. Methotrexate as 12.5 mg/week was added after the second dose of inXiximab. Because the hearing conditions remained stable oral prednisone was reduced gradually. Patient was lost of follow up after the third dose of inXiximab and returned after 2 years. She has stopped her medications since then and found to have subjective and objective deterioration for which she underwent left cochlear implant.

Successful retreatment with infliximab in patients with prior severe infusion reactions

Infusion of the antitumor necrosis factor-α chimeric monoclonal antibody infliximab can be associated with the development of severe infusion reactions (IR) during retreatment. We present the case of two rheumatoid arthritis patients with a history of severe acute IR to infliximab who subsequently underwent successful infusion using a prophylactic treatment with a combination of H1 and H2 receptor blockers, hydrocortisone, and diphenhydramine.

Endobronchial stenting for respiratory complications in relapsing polychondritis

Relapsing polychondritis is characterized by recurrent inflammation and destruction of the cartilage and connective tissue. Respiratory complications are frequently severe during the course of the disease and usually signal a poor prognosis. We report a case of a 47-year-old man with known relapsing polychondritis who presented with bilateral narrowing of the airways complicated by refractory cavitary Pseudomonas aeruginosa pneumonia. Despite an aggressive antibiotic regimen, the patient’s pneumonia did not improve until bronchial stenting 4xa0months later.

Family history of lymphoma and risk for solid tumors in patients with Sjogren's syndrome.

It has been recognized that primary Sjogren’s syndrome predisposes to the development of lymphoproliferative disorders. However, it is so far uncertain whether these patients are at an increased risk for solid tumors. Herein we report two cases of primary Sjogren’s syndrome complicated by breast and lung cancer and who have a strong family history for lymphoproliferative diseases.

Topical nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis

Osteoarthritis is the most common degenerative joint disease and is particularly common in the elderly. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) may represent a rational treatment in this situation because of their favorable side-effect profile. The majority of topical NSAIDs decrease pain and relieve functional disability caused by osteoarthritis over the short term, however, there are insufficient data for their long-term efficacy.