title: [Pulmonary sarcoidosis developing during treatment with etanercept].
abstract: BACKGROUND
  TNF blockers are widely used to treat inflammatory rheumatic diseases and also in the treatment of extrapulmonary sarcoidosis. TNFα plays a major role in the development and persistence of sarcoid granulomata. However, recent studies have reported the involvement of anti-TNF therapies in the development of granulomatosis associated with the clinical and radiological features of sarcoidosis.
  
  
  METHODS
  A 54-years-old man with ankylosing spondylitis was treated with etanercept for two years. He was admitted with symptoms of bronchitis associated with radiological evidence of bilateral pulmonary nodules and a right upper lobe infiltrate. Anti-TNF therapy was stopped even though the patient had received 3 months of prophylactic treatment with rifampicin and isoniazid before starting etanercept. Bronchoalveolar lavage excluded infection, particularly tuberculosis. The chest CT-scan showed bilateral pulmonary nodules with peribronchovascular micronodules and enlarged mediastinal lymph nodes. Surgical lung biopsy was performed and revealed non-caseating granulomata. All the data were consistent with a diagnosis of pulmonary sarcoidosis. The patient remained symptomatic despite discontinuation of etanercept for ten months. Corticosteroids were then introduced, leading to a clinical, functional and radiological improvement.
  
  
  CONCLUSIONS
  This case report underlines the importance of studying the pulmonary complications of TNF blockers. The first priority is to exclude tuberculosis but a diagnosis of sarcoid-like granulomatosis has to be considered. Twenty-three cases have been described in the literature to date.
authors.affiliation: Service de pneumologie, hôpital Pontchaillou, CHU de Rennes, 2 rue Henri-Le-Guilloux, Rennes, France. mallorie.kerjouan@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Kerjouan
authors.forename: S
authors.initials: S
authors.lastname: Jouneau
authors.forename: H
authors.initials: H
authors.lastname: Lena
authors.forename: R
authors.initials: R
authors.lastname: Luraine
authors.forename: B
authors.initials: B
authors.lastname: Desrues
authors.forename: P
authors.initials: P
authors.lastname: Delaval
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000068800:Etanercept; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage; D017565:Sarcoidosis, Pulmonary / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000188:drug therapy; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept