title: Adalimumab induced pulmonary sarcoid reaction.
abstract: Sarcoidosis is a multisystem granulomatous inflammatory disease of unknown etiology. There is evidence that Tumor Necrosis Factor alpha (TNF-α) antagonists are useful in the treatment of advanced or refractory disease. However, sarcoidosis-like reaction has been reported with TNF-α blockade in other inflammatory conditions. Here we report a case of sarcoid-like reaction in a patient with psoriatic arthritis shortly after initiation of adalimumab therapy. Stopping adalimumab and systemic anti-inflammatory therapy with corticosteroids resulted in resolution of pulmonary symptoms and chest radiographic findings. Though TNF-α plays a critical role in pathogenesis of sarcoidosis, the development of sarcoid reaction with TNF-α blockade is paradoxical and the mechanism of this response remains unknown. TNF-α induced sarcoid-reaction could involve multiple organs. Its development with one agent does not preclude therapy with other TNF-α blockers.
authors.affiliation: Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Bhargava
authors.affiliation: Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Perlman
authors.affiliation: Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Allen
authors.affiliation: Department of Pathology, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Ritter
authors.affiliation: Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bhargava
keywords: Adalimumab; Sarcoid reaction; TNF blockers