Infliximab-associated sarcoid-like reaction and haemophagocytic lymphohistiocytosis in multisystem sarcoidosis

Drug-associated sarcoidosis-like reactions and drug-associated haemophagocytic lymphohistiocytosis (HLH) are rare immune-mediated complications, each associated with significant diagnostic and therapeutic challenges. We report a man with multisystem sarcoidosis who developed concurrent drug-associated sarcoid-like reaction and secondary HLH following initiation of infliximab therapy. The diagnosis was supported by characteristic imaging findings, laboratory evidence of hyperinflammation and a clear temporal relationship to infliximab exposure, with clinical improvement after drug discontinuation and immunosuppressive therapy.