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. 2013 Oct 26:10:53-5.
doi: 10.1016/j.rmcr.2013.07.002. eCollection 2013.

Adalimumab induced pulmonary sarcoid reaction

S Bhargava  1 , D M Perlman  1 , T L Allen  2 , J H Ritter  3 , M Bhargava  1
Affiliations

Adalimumab induced pulmonary sarcoid reaction

S Bhargava et al. Respir Med Case Rep. .

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.

Keywords: Adalimumab; Sarcoid reaction; TNF blockers.

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Figures

Fig. 1
Fig. 1
Chest CT scan images lung windows (panel A and C) and mediastinal windows (panel B and D). At presentation the lung windows demonstrated bilateral asymmetric perilymphatic distributed micronodular opacities (Galaxy Sign- Panel A) and bilateral hilar and subcarinal lymphadenopathy (panel B). Subsequent chest CT scan images at 23 months showed complete resolution of the parenchymal micronodules with significant improvement of the lymphadenopathy except mildly enlarged right hilar lymph node.
Fig. 2
Fig. 2
Transbronchial biopsies performed at presentation reveal non-caseating, well-formed granulomas involving lung tissue. No fungal or acid-fast organisms were identified (with appropriate controls).
See this image and copyright information in PMC

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