[Successful treatment with infliximab of a patient with refractory sarcoidosis]. / Succesvolle behandeling met infliximab van een patient met therapieresistente sarcoïdose

A 35-year-old patient had persistent, refractory symptomatic pulmonary sarcoidosis, complicated by a rare congenital muscular disease: McArdle's disease (a glycogen storage disease caused by myophosphorylase deficiency). As the desaturations during mild exercise caused by the sarcoidosis aggravated the negative consequences of his muscle disease and he failed to respond adequately to corticosteroids and methotrexateimmunosuppressive agents, the patient was successfully treated experimentally with infliximab, a monoclonal antibody and specific tumour necrosis factor alpha (TNF-alpha) inhibitor. The results were favourable: after 17, 21 and 36 months there was an improvement in various lung function parameters, his fatigue was reduced and the patient had been able to resume his work as a taxi driver. TNF-alpha appears to be an important mediator of clinical disease in sarcoidosis and infliximab could be a promising therapy for patients with refractory sarcoidosis.

[The role of allergy in interstitial cystitis]. / De rol van allergie bij interstitiële cystitis.

In two women, aged 47 and 58 years, who suffered from longstanding urinary bladder complaints, various urologic treatments had been carried out, which however had had only a partial therapeutic effect. They also suffered from allergic rhinitis and multiple arthralgia. Allergologic investigations including nasal challenges with inhalant allergens and food ingestion challenges revealed the causative participation of the inhalant allergens and the food components in the urinary complaints. The all-round allergologic management, including dietary measures, avoidance of the relevant allergens and nasal as well as oral administration of disodium cromoglycate therapy, led to the almost complete disappearance of the urinary and other complaints. Interstitial cystitis is a regularly appearing urinary disorder, especially in female patients. In practice, the possible causative role of allergy and especially of food allergy is only rarely included in the differential diagnosis of this disorder.