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270 TACROLIMUS: A NEW OPTION IN TREATING REFRACTORY SYSTEMIC SARCOIDOSIS W Al-hamoudi, A Al-qutub, P Marotta BACKGROUND: Sarcoidosis is a multisystem granulomatous disorder of unknown etiology. Liver involvement is relatively common and in some cases can lead to significant fibrosis and liver cirrhosis. We report a case of refractory sarcoidosis with liver involvement responding dramatically to tacrolimus.
London Health Sciences Centre, London, Ontario
CASE: A 45-year-old Caucasian male presented initially in March of 2002 with progressive shortness of breath and a persistent cough. His past medical history was otherwise unremarkable. Initial work up included an abnormal chest x-ray consistent with stage II sarcoidosis and a restrictive pattern on pulmonary function test. He subsequently underwent a transbronchial biopsy confirming the diagnosis of sarcoidosis. A preceding infectious work up including TB testing was negative. He required high dose prednisone initially to control his disease. Reduction of prednisone below 15 mg resulted in disease flare up, as a result of that he developed osteopenia, obesity, hypertension, and significant weight gain. In January of 2005 he was referred to the Hepatology service because of a persistent elevation in his liver enzymes. A liver workup to rule out underlying metabolic, autoimmune, and viral liver disease was negative. Subsequently he had a liver biopsy that revealed granulomatous hepatitis and stage III fibrosis consistent with sarcoidosis.
This aggressive liver involvement was unexpected in view of the high prednisone requirements in the past. A combination of ursodeoxycholic acid 1500 mg and tacrolimus 2 mg bid was initiated and tacrolimus level was maintained between 5-8. This resulted in normalization of his liver enzymes associated with histological improvement. Furthermore, his pulmonary sarcoidosis remained under control with improvement in both his radiological and pulmonary function testing on further prednisone tapering.
CONCLUSION: Tacrolimus is a promising agent in the treatment of systemic sarcoidosis. To our knowledge this is the first report of its use in refractory sarcoidosis with advanced liver involvement.