title: [Severe hypercalcemia revealing sarcoidosis precipitated by etanercept].
abstract: BACKGROUND
  The principal secondary effects of anti-TNF alpha therapy are now well understood, particularly the risk of opportunistic infections. Other paradoxical effects have been described much more occasionally such as the developement of sarcoid-like granulomatous reactions.
  
  
  METHODS
  We report here the case of a woman of 39 years treated for severe rheumatoid arthritis for five years with etanercept. She was admitted to hospital as an emergency with vomiting and diffuse abdominal pain. Investigations revealed severe hypercalcaemia and acute renal failure. After correction of the metabolic disturbances with rehydration and biphosphonates, CT scanning of the abdomen, pelvis and thorax showed bilateral interstitial infiltration and splenomegaly. The diagnosis of sarcoidosis was confirmed by endoscopic bronchial biopsies. Progress was satisfactory following withdrawal of the etanercept and corticosteroid therapy in reducing dosage.
  
  
  CONCLUSIONS
  The risk of induced sarcoidosis should be understood in patients receiving anti-TNF therapy and should be considered in cases of hypercalcaemia and/or splenomegaly.
authors.affiliation: Département de pneumologie, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 9, France; Université Nantes-Angers-Le-Mans, Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Watrin
authors.affiliation: Université Nantes-Angers-Le-Mans, Angers, France; Service de rhumatologie, CHU d'Angers, 49033 Angers cedex 9, France.
authors.forename: M
authors.initials: M
authors.lastname: Royer
authors.affiliation: Université Nantes-Angers-Le-Mans, Angers, France; Service de rhumatologie, CHU d'Angers, 49033 Angers cedex 9, France.
authors.forename: E
authors.initials: E
authors.lastname: Legrand
authors.affiliation: Département de pneumologie, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 9, France; Université Nantes-Angers-Le-Mans, Angers, France. Electronic address: frgagnadoux@chu-angers.fr.
authors.forename: F
authors.initials: F
authors.lastname: Gagnadoux
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D000068800:Etanercept; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D007074:Immunoglobulin G / Q000009:adverse effects*; D018124:Receptors, Tumor Necrosis Factor; D012507:Sarcoidosis / Q000139:chemically induced* / Q000175:diagnosis*; D013163:Splenomegaly / Q000209:etiology
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept
keywords: Anti-TNF; Etanercept; Hypercalcaemia; Hypercalcémie; Sarcoidosis; Sarcoïdose; Splenomegaly; Splénomégalie; Étanercept