title: Etanercept may induce neurosarcoidosis in a patient treated for rheumatoid arthritis.
abstract: BACKGROUND
  TNFα blockers have drastically improved rheumatoid arthritis prognosis by preventing joint destruction in DMARD resistant patients. Altering cytokine balance in immune diseases may expose to paradoxical adverse events.
  
  
  METHODS
  We present the case of a 40-year-old woman, with a confirmed erosive and seropositive RA, successfully treated by TNFα blocker (etanercept) for seven years, and who developed a severe neurosarcoidosis. She had lymphocytic meningitis, bilateral peripheral facial paralysis and anosmia, associated with bilateral hilar lymph nodes, papilloedema, anterior uveitis and elevated serum angiotensin-converting enzyme level. Magnetic resonance imaging showed a bilateral thickening of the Gasser's ganglia walls and enhanced signal of the vestibulocochlear, the facial and the proximal portion of trijeminal nerves.
  
  
  CONCLUSIONS
  This case raised the issue of the imputability of etanercept in the development of neurosarcoidosis. Neurological symptoms onset in patients on TNFα blockers should lead to exclude infections, induced lupus but also paradoxical neurosarcoidosis.
authors.affiliation: Department of Internal Medicine, Hôpital Edouard Herriot, Université de Lyon, Hospices Civils de Lyon, Lyon 69003, France. cecile-au@orange.fr.
authors.forename: Cécile-Audrey
authors.initials: CA
authors.lastname: Durel
authors.forename: Elodie
authors.initials: E
authors.lastname: Feurer
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Pialat
authors.forename: Emilie
authors.initials: E
authors.lastname: Berthoux
authors.forename: Roland D
authors.initials: RD
authors.lastname: Chapurlat
authors.forename: Cyrille B
authors.initials: CB
authors.lastname: Confavreux
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000473:pathology; D002493:Central Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D018124:Receptors, Tumor Necrosis Factor; D012507:Sarcoidosis / Q000139:chemically induced* / Q000175:diagnosis; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept