Infliximab Monotherapy as First-Line Treatment for Hepatic, Splenic, and Pulmonary Sarcoidosis in a Patient With High Cardiometabolic Risk

Glucocorticoids remain the first-line treatment for pulmonary and extrapulmonary sarcoidosis, with antitumor 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-yearold 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.