Case Conference: Methotrexate and Increased Infection Risk in Sarcoidosis
Treatment
Kang Rui Xiang
December 17, 2023
December 17, 2023
Case
- 69 year old male with sarcoidosis on chronic prednisone with newly started methotrexate presents after legionella pneumonia.
- MHx: OSA on CPAP, CKD4, T2DM on insulin pump, hypothyroidism.
Sarcoid History
- Initially diagnosed in 2016-2017
- Several months of fatigue, weakness, increased thirst, and new onset cough
- Had CT finding of increased mediastinal adenopathy that was hypermetabolic on PET CT
Sarcoid History
- Had EBUS-TBFNA negative for cancer, no granulomas, elevated CD4:CD8 count
- Seen at Mayo Clinic with mediastinoscopy that was also negative
- Also found to have significant hypercalcemia to 16
- Diagnosed with sarcoidosis by exclusion
Sarcoid History
- Started on prednisone 40 mg for 1 month and subsequently tapered by 10 mg each month
- Now on 10 mg daily since
- In the past has tried taper below 10mg but with recurrence of hypercalcemia
- PFT with normal spirometry and DLCO. No real respiratory complaints
Clinical Questions
- In patients with sarcoidosis, does methotrexate use increase risk for legionella pneumonia?
Case Conference: Methotrexate and Increased Infection Risk in Sarcoidosis
Treatment Kang Rui Xiang December 17, 2023