Orbital Sarcoid-Like Granulomatosis After Inhibition of Tumor Necrosis Factor-α.
Pharmacologic inhibition of tumor necrosis factor-alpha (TNF-α) has been used in the management of a variety of inflammatory conditions. Recently, reports on the development of sarcoid-like granulomatous disease at multiple systemic sites after treatment with TNF-α inhibitors have emerged, although, to the authors' knowledge, orbital manifestations of this problem have not been previously described. A 48-year-old woman who received injections of adalimumab for the treatment of psoriatic arthritis developed right-sided orbital pain and inflammation. Orbital biopsy of a focal lesion demonstrated sarcoid-like granulomatosis, and a workup for other causes of this problem was noncontributory. This report represents the first documented case of this phenomenon in the orbit, and possible mechanisms are discussed in this presentation. Given the expanding role of TNF-α inhibitors and the increased frequency of their use, clinicians should be aware of this possible side effect.
*Ophthalmic Plastic Surgery, Department of Ophthalmology, Lions Eye Institute, †Department of Pathology, ‡Department of Ophthalmology, Lions Eye Institute, and §Division of Rheumatology, Department of Medicine, Albany Medical College, Albany, New York, U.S.A.
Edward J
EJ
Wladis
Ashley J
AJ
Tarasen
Zachary J
ZJ
Roth
Martha G
MG
Farber
Jeffrey
J
Ross
Victoria M
VM
Michaels
D000068879:Adalimumab / Q000009:adverse effects*; D000284:Administration, Oral; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D004359:Drug Therapy, Combination; D058447:Eye Pain / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006099:Granuloma / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009916:Orbital Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D011241:Prednisone / Q000008:administration & dosage; D012507:Sarcoidosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D011241:Prednisone; D008727:Methotrexate