title: Thymic enlargement in a patient with juvenile idiopathic arthritis during etanercept therapy.
abstract: Tumor necrosis factor (TNF) alpha inhibitors are effective in the treatment of inflammatory rheumatic diseases. Despite their effectiveness, anti-TNF drugs have some drawbacks such as severe adverse effects including infections and possibly lymphoproliferative disorders. In this report we described a case of juvenile idiopathic arthritis patient who developed thymic enlargement (true thymic hyperplasia), mediastinal lymphadenopathy and pleurisy associated with systemic symptoms under Etanercept treatment. The clinical presentation was highly suggestive of malignancy and the patient underwent diagnostic mediastinoscopy with biopsy.
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Sari
authors.forename: Omer
authors.initials: O
authors.lastname: Binicier
authors.forename: Merih
authors.initials: M
authors.lastname: Birlik
authors.forename: Servet
authors.initials: S
authors.lastname: Akar
authors.forename: Erkan
authors.initials: E
authors.lastname: Yilmaz
authors.forename: Aydanur
authors.initials: A
authors.lastname: Kargi
authors.forename: Fatos
authors.initials: F
authors.lastname: Onen
authors.forename: Nurullah
authors.initials: N
authors.lastname: Akkoc
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D003937:Diagnosis, Differential; D000068800:Etanercept; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D007155:Immunologic Factors / Q000009:adverse effects*; D008206:Lymphatic Diseases / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000601:surgery; D008481:Mediastinoscopy; D018124:Receptors, Tumor Necrosis Factor; D011993:Recombinant Fusion Proteins / Q000009:adverse effects*; D013950:Thymus Gland / Q000000981:diagnostic imaging / Q000187:drug effects*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; D011993:Recombinant Fusion Proteins; D000068800:Etanercept