title: Sarcoidosis triggered by interferon-Beta treatment of multiple sclerosis: a case report and focused literature review.
abstract: OBJECTIVE
  To report a rare case of sarcoidosis induced by chronic interferon-beta (a type I interferon) therapy of multiple sclerosis and to review previously reported cases.
  
  
  METHODS
  We describe a patient with a prior diagnosis of multiple sclerosis, who developed noncaseating granulomas in her skin and pulmonary lymph nodes, consistent with sarcoidosis, while being treated with recombinant interferon-beta. A retrospective review of the literature was performed using the PubMed database.
  
  
  RESULTS
  In our patient, sarcoidosis developed after 3 years of continuous recombinant interferon-beta therapy, dosed 3 times a week. The patient presented with progressive dyspnea on exertion, diffuse arthralgias, low-grade fevers, with an acute onset of rash. The diagnosis of sarcoidosis was secured by finding typical, well-formed, noncaseating granulomas on skin and endobronchial biopsies, with other possible etiologies for granulomatous conditions excluded beforehand. Following the withdrawal of recombinant interferon-beta and a course of corticosteroids combined with disease-modifying anti-rheumatic drug therapy, the patient's clinical presentation resolved. Excluding ours, only 4 additional cases of sarcoidosis developing after interferon-beta therapy have been reported, with 2 of those cases in the context of underlying multiple sclerosis.
  
  
  CONCLUSIONS
  Developing sarcoidosis during treatment of multiple sclerosis with recombinant interferon-beta represents an exceedingly rare and paradoxical adverse event. The occurrence of sarcoidosis with the use of this agent is perhaps due to a dysregulation in the modulatory role played by interferon-beta (and more generally type I interferon) expression in chronic inflammation.
authors.affiliation: Division of Rheumatology, Hospital for Special Surgery and Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY 10021, USA. chakravartys@hss.edu
authors.forename: Soumya D
authors.initials: SD
authors.lastname: Chakravarty
authors.forename: Mary E
authors.initials: ME
authors.lastname: Harris
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Schreiner
authors.forename: Mary K
authors.initials: MK
authors.lastname: Crow
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D016899:Interferon-beta / Q000009:adverse effects* / Q000276:immunology; D008727:Methotrexate / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D011241:Prednisone / Q000627:therapeutic use; D013902:Radiography, Thoracic; D012507:Sarcoidosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D014057:Tomography, X-Ray Computed
chemical_list: D006886:Hydroxychloroquine; D016899:Interferon-beta; D011241:Prednisone; D008727:Methotrexate