Pulmonary Sarcoidosis following Etanercept Treatment for Ankylosing Spondylitis: A Case Report and Review of the Literature

Antitumor necrosis factor therapies have revolutionized the treatment of some inflammatory diseases. However, the use of these agents is associated with the development of many paradoxical autoimmune diseases. Less well-recognized is the association with sarcoidosis. We report a 55-year-old female w...

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Bibliographic Details
Published in:	Case reports in rheumatology Vol. 2018; no. 2018; pp. 1 - 4
Main Authors:	El Ochi, M. R., Biyi, A., Bezza, A., Majjad, A., El Maghraoui, Abdellah
Format:	Journal Article
Language:	English
Published:	Cairo, Egypt Hindawi Publishing Corporation 2018 Hindawi John Wiley & Sons, Inc Hindawi Limited
Subjects:	Adalimumab Ankylosing spondylitis Arthritis Biopsy Care and treatment Case Report Case reports Dyspnea Enzymes Etanercept Family medical history Hepatitis Hospitals Hypotheses Immunoglobulins Lungs Lymphatic system Lymphocytes Medicine Pathogenesis Pharmacy Rheumatology Sarcoidosis Tuberculosis Tumor necrosis factor-TNF Morocco
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Summary:	Antitumor necrosis factor therapies have revolutionized the treatment of some inflammatory diseases. However, the use of these agents is associated with the development of many paradoxical autoimmune diseases. Less well-recognized is the association with sarcoidosis. We report a 55-year-old female with long-standing ankylosing spondylitis who developed persistent dry cough and dyspnea while receiving etanercept therapy. High-resolution computed tomography scanning showed mediastinal lymphadenopathy and multiple nodules in both lung fields developed two months after the administration of etanercept. Lymph node biopsy was not practicable. Histopathological examination of minor salivary gland biopsy revealed noncaseating granulomata, and the serum angiotensin-converting enzyme was very elevated. All infectious studies were negative. Etanercept was discontinued plus a course of corticosteroids with a clinical improvement, and a follow-up high-resolution computed tomography scanning 4 months later showed evident regression of mediastinal lymph nodes and pulmonary nodules. Potential pathogenic mechanisms of this paradoxical effect of tumor necrosis factor-alpha blocking agents are discussed.
Bibliography:	Academic Editor: Tsai-Ching Hsu
ISSN:	2090-6889 2090-6897
DOI:	10.1155/2018/9867248