Shin'ichiro Morimoto

Because of the marked side effects associated with conticosteroid use, a switch was made to methotrexate therapy in 4 patients with cardiac sarcoidosis and the utility of this agent was investigated. As side effects induced by methotrexate, anaplastic anemia developed in one case and liver dysfunction in two. In the former case, when this agent was discontinued and G-CSF (granulocyte-colony stimulating factor) filgrastim was administered, swift improvement was attained. In the two cases with liver dysfunction, dosage reduction was required. In the remaining case, despite the absence of obvious side effects, the switch to this agent was associated with a resurgence of sarcoidosis activity, necessitating a switch back to cordicosteroid administration. Accumulation of further experience with methotrexate therapy for cardiac sarcoidosis is awaited. Our present experience was not promising in that methotrexate therapy could not be considered effective in 3 of the 4 cases.