Table 1.
Case 1 | Case 2 | Case 3 | |
---|---|---|---|
Demographics | 43-year-old African American man | 53-year-old African American woman | 48-year-old African American woman |
Other organ involvement | Pulmonary | Pulmonary and eye | Pulmonary and eye |
Cutaneous features at diagnosis | Nodular lesions on face, eyelids, and earlobes | Multiple erythematous to violaceous papules on eyelids, right cheek, tip of nose, and corner of mouth | Multiple erythematous annular plaques around eyes, nose, perioral area, neck, arm, back and knees |
Histopathology | From right cheek: granulomatous inflammatory infiltrate (lymphocytes, histiocytes, and giant cells) | From right cheek: non-necrotizing granulomas (epithelioid cells and multinucleated giant cells) | N/A |
Previous treatment before initiating infliximab |
Prednisone Hydroxychloroquine Intralesional corticosteroids |
Prednisone Hydroxychloroquine Methotrexate Minocycline Topical tacrolimus Topical imiquimod Mycophenolate mofetil |
Prednisone Hydroxychloroquine Methotrexate Pulse methyl prednisone Thalidomide Topical corticosteroids |
Therapeutic side effects or complications |
A significant amount of weight gain Hypertension New onset diabetes A spontaneous hairline left 5th metatarsal fracture |
Hypertension Diabetes Right hip avascular necrosis |
Corticosteroids-induced gastrointestinal upset, fatigue Hydroxychloroquine-induced diarrhea and abdominal pain Methotrexate-induced leucopenia and abnormal liver function tests Thalidomide-induced peripheral neuropathy |
Duration of disease before infliximab therapy | 2 years | 18 years | 8 years |
Treatments used at the time of infliximab initiation |
Hydroxychloroquine (200 mg twice a day) Intralesional corticosteroids |
Mycophenolate mofetil (4 g/day) Prednisone (15 mg/day) |
Prednisone (40 mg/day) Thalidomide (100 mg/day) |
Infliximab dose, duration | 5 mg/kg on weeks 0, 2, and 6, then every 8 weeks 6 months later: add methotrexate 7.5 mg weekly after tapering prednisone 6 months later increased infliximab to 5 mg/kg and 7.5 mg/kg every 7 weeks 9 months later increased infliximab to 10 mg/kg every 5 weeks | 7.5 mg/kg on weeks 0, 2, and 6, then every 8 weeks |
7.5 mg/kg on weeks 0, 2, and 6, then every 8 weeks 4 years later tapered to 5 mg/kg every 16 weeks 3 years later taken off infliximab |
Time to achieve clinical response | 3 years | 5 months | 4 years |
Treatments at the time of last follow-up |
Infliximab (10 mg/kg every 5 weeks) Methotrexate (7.5 mg weekly) Prednisone (2.5 mg/day every other day) |
Infliximab (7.5 mg/kg every 8 weeks) | Discontinued infliximab |
Follow-up | Still gradually increase new lesions | Improvement after mycophenolate mofetil and prednisone discontinuation | No new lesions |