title: Sarcoidosis-Like Lesions: Another Paradoxical Reaction to Anti-TNF Therapy?
abstract: BACKGROUND
  Since the introduction of anti-tumour necrosis factor [TNF] therapy in inflammatory diseases, paradoxical reactions are increasingly being reported. One of these paradoxical reactions is the development of sarcoidosis-like lesions. This presentation is paradoxical since anti-TNF therapy can also be therapeutic in refractory cases of sarcoidosis.
  
  
  METHODS
  We report two cases of sarcoidosis-like lesions under anti-TNF therapy. Both were patients with inflammatory bowel disease [IBD], treated successfully with adalimumab. Next, we reviewed the literature for similar cases. Medical subject heading terms 'adalimumab', 'infliximab', 'etanercept', 'golimumab' or 'certolizumab', and 'sarcoidosis' were used to perform key word searches of the PubMed database.
  
  
  RESULTS
  We identified 90 reported cases of sarcoidosis-like lesions, which developed during anti-TNF therapy. In most cases, the anti-TNF drug involved was etanercept. The median age was 43 years and there was a predominance of female patients. The underlying disease was rheumatoid arthritis in most cases, followed by ankylosing spondylitis and psoriasiform arthritis. In six cases, the underlying disease was IBD. In 71 cases there was at least a partial resolution by discontinuation of the anti-TNF treatment, initiation of steroids or both. Re-initiation of anti-TNF therapy gave relapse in seven out of 20 cases.
  
  
  CONCLUSIONS
  Sarcoidosis-like lesions are increasingly reported during anti-TNF treatment. Vigilance is appropriate when patients present with symptoms compatible with sarcoidosis.
authors: Department of Internal Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors: Amelie
authors: A
authors: Decock
authors: Department of Gastroenterology and Hepatology, UZ Leuven, University Hospitals Leuven, Leuven, Belgium.
authors: Gert
authors: G
authors: Van Assche
authors: Department of Gastroenterology and Hepatology, UZ Leuven, University Hospitals Leuven, Leuven, Belgium.
authors: Séverine
authors: S
authors: Vermeire
authors: Department of Respiratory Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors: Wim
authors: W
authors: Wuyts
authors: Department of Gastroenterology and Hepatology, UZ Leuven, University Hospitals Leuven, Leuven, Belgium.
authors: Marc
authors: M
authors: Ferrante
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D000068582:Certolizumab Pegol / Q000009:adverse effects; D003424:Crohn Disease / Q000188:drug therapy; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D000068800:Etanercept / Q000009:adverse effects; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects; D008297:Male; D012507:Sarcoidosis / Q000139:chemically induced*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D000068582:Certolizumab Pegol
keywords: Inflammatory bowel disease; sarcoidosis; tumour necrosis factor antagonists and inhibitors