Development of sarcoidosis during etanercept therapy.
This report describes a 65-year-old woman who developed granulomatous lesions consistent with sarcoidosis during etanercept therapy for rheumatoid arthritis. Hilar and mediastinal lymphadenopathy and multiple nodules in both lung fields developed 21 months after administration of etanercept. Noncaseating epithelioid cell granulomas consistent with sarcoidosis were detected in a lung biopsy specimen and in the parietal pleura obtained via thoracotomy. Diseases showing similar histologic changes were excluded, and a diagnosis of sarcoidosis was made. Etanercept was discontinued, which resulted in symptomatic relief, improvement of oxygenation and radiologic findings. There is substantial evidence of tumor necrosis factor-alpha involvement in the induction and maintenance of granuloma formation; however, we should keep in mind that granulomatous disease, such as sarcoidosis, can develop during treatment with a tumor necrosis factor-alpha blocking agent, such as etanercept.
Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya. ishiguro@med3.m.kanazawa-u.ac.jp
Takashi
T
Ishiguro
Noboru
N
Takayanagi
Kazuyoshi
K
Kurashima
Aya
A
Matsushita
Keiji
K
Harasawa
Koichiro
K
Yoneda
Noriko
N
Tsuchiya
Yousuke
Y
Miyahara
Shozaburo
S
Yamaguchi
Ryozo
R
Yano
Daidou
D
Tokunaga
Hiroo
H
Saito
Mikio
M
Ubukata
Tsutomu
T
Yanagisawa
Yutaka
Y
Sugita
Yoshinori
Y
Kawabata
D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D018124:Receptors, Tumor Necrosis Factor; D017565:Sarcoidosis, Pulmonary / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept