A case of acute sarcoid myositis treated with weekly low-dose methotrexate

Abstract

A 25-year-old man was referred to our hospital with a 2-month history of progressive proximal extremity weakness. His serum creatine kinase (CK) level was extremely elevated, and chest X-ray revealed bilateral hilar lymphadenopathy and small nodules in bilateral lung fields. Biopsy specimens obtained from muscle and lung revealed non-caseating epithelioid cell granulomas. On the basis of these findings, the patient was diagnosed with sarcoidosis and acute sarcoid myositis. Although steroid pulse therapy was administered repeatedly, the muscle symptoms did not improve, and the serum CK level remained high. We added 7.5 mg oral methotrexate once per week to oral prednisolone, and this improved both the muscle weakness and the CK level. Concurrent administration of methotrexate could be a therapeutic option for cases with acute sarcoid myositis refractory to steroid therapy.