Interferon-induced granulomatous lung disease

Marzouk, Kamel; Saleh, Samer; Kannass, Mouhamed; Sharma, Om P.

doi:10.1097/01.mcp.0000134400.88832.9c

Cited by 38 publications

(19 citation statements)

References 28 publications

(27 reference statements)

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“…Some treatments may cause granulomatosis, such as BCG therapy for treatment of bladder cancer, interferon alfa and beta for treatment of malignant melanoma, IL-2 for renal cell carcinoma, or methotrexate (18).…”

Section: Discussionmentioning

confidence: 99%

Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Arco¹,

Fernández-Aceñero²

2016

J. Gastrointest. Oncol.

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Granulomatous reactions are related to infectious and non infectious diseases, but more rarely, granulomas may occur in association to malignancies. The presence of sarcoid-like granulomas in lymph nodes draining malignant tumors is an uncommon but well known occurrence. However, their presence in the stroma of malignant tumors is much rarer. We have only found two previous cases reported in the Japanese and English literature. In this study we report a well differentiated adenocarcinoma of the right colon associated to a stromal granulomatous sarcoid-like reaction. Lymph nodes were not involved. The patient had a clinical history of tuberculosis treated 15 years ago, but there was no clinical, histomorphological, immunohistochemical or molecular evidence of disease at the moment of these findings.We have reviewed the literature to find the keys and the diagnostic challenges posed by granulomatous sarcoid-like reaction occurring in lymph nodes draining malignant neoplasms, peritumoral stroma and in other organs far from the primary tumor. The diagnosis of granulomatous sarcoid-like reactions associated to malignancies can be challenging and it can only be made after ruling out specific infectious and non infectious causes of granulomatous inflammation. The mechanisms involved in granuloma formation, their relationship with demographic and histopathological features, their possible association with autoimmune disorders, their cytokine profile and, more importantly, their prognostic significance in each type of tumor are still unclear and require studies with larger number of patients. J Gastrointest Oncol 2016;7(4):E72-E76 jgo.amegroups.com of pulmonary tuberculosis treated for 9 months 15 years before. Computed tomography (CT) revealed a mass in the right colon and he underwent colonoscopy. Colonoscopy revealed an excrescent mass in the cecum and ileocecal valve with partial stenosis of the lumen. Biopsies showed a well differentiated adenocarcinoma. A right hemicolectomy was subsequently performed. Postoperative course was complicated by fever due to a possible dehiscence of the anastomosis with air bubbles near the ileal loop, but the patient evolved well and was finally discharged and is currently being followed in the surgery outpatient clinics.The surgical specimen consisted of ileum, caecum and right colon measuring 26 cm in length. In the ascending colon there was an excrescent lesion with well defined high borders and a central concavity. It was circumferential and obliterated 90% of the colonic lumen. It measured 7 cm × 4.5 cm and infiltrated through the wall into the adjacent fat.Microscopic examination confirms an infiltrating moderately differentiated colonic carcinoma extending into the subserosal fat. It shows an infiltrative leading edge without budding or desmoplasia and a moderate intratumoral and peritumor lymphocytic response. Metastases were found in 1 of 36 lymph nodes examined. Immunohistochemistry for mismatch repair proteins showed intact nuclear positivity. There was a granulom...

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Section: Discussionmentioning

confidence: 99%

Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Arco¹,

Fernández-Aceñero²

2016

J. Gastrointest. Oncol.

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“…IFN-alpha and IFN-beta can activate antigen-presenting cells and stimulate them to release proinflammatory cytokines such as IL-12, TNF apha and IFN gamma. Recent studies have shown that IFN-alpha also stimulates NK cells to produce IFN-gamma, leading to Th1 differentiation and reducing Th2 cell activation [10,15,18,26,37]. Stimulated Th1 cells activate macrophages and enhance the differentiation of mononuclear cells into epitheloid cells and the granuloma formation.…”

Section: Discussionmentioning

confidence: 99%

Interferon-alpha-associated presumed ocular sarcoidosis

Doycheva¹,

Deuter²,

Stuebiger³

et al. 2008

Graefes Arch Clin Exp Ophthalmol

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“…Management includes the discontinuation of IFN therapy with or without the administration of systemic corticosteroids [12]. Most patients will have complete resolution of the disease within a few months of discontinuing interferon therapy, without the need for immunosuppressants [13]. The prognosis for IFN-alpha-induced sarcoidosis is very good, with improvement once medication is discontinued [14].…”

Section: Discussionmentioning

confidence: 99%

Interferon-alpha-induced sarcoidosis in a patient being treated for hepatitis C

et al. 2014

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Patient: Female, 43Final Diagnosis: —Symptoms: Diarrhea • generalized weakness • headache • lightheadedness • nausea • rash • short of breath • vomitingMedication: —Clinical Procedure: —Specialty: PulmonologyObjective:Rare diseaeBackground:IFN-alpha-2b in combination with ribavirin is now the standard of care for the treatment of hepatitis C. Sarcoidosis is a chronic multisystem granulomatous disorder characterized by noncaseating granulomas in the involved organs. The pathologic hallmark of sarcoidosis is the presence of noncaseating granulomas in the interstitium that typically involve the lymphatics.Case Report:A 43-year-old woman presented to our care with 2-week history of nausea, vomiting, diarrhea, shortness of breath, migraine headache, maculopapular rash, generalized weakness, and lightheadedness. She had been treated for hepatitis C with telaprevir, ribavirin, and interferon-alpha-2b for 6 months. Chest radiograph showed bilateral diffuse prominence of bronchovascular markings. CT of the chest revealed bilateral diffuse centrilobular nodules with associated intralobular septal thickening, thickening of the central peribronchovascular interstitium, nodularity of the major fissures, and mediastinal lymphadenopathy. These findings were suspicious for atypical pulmonary sarcoidosis, possibly interferon-induced. The pathology of the mediastinal lymph node biopsy revealed noncaseating granulomatous inflammation consistent with the diagnosis of pulmonary sarcoidosis. Pathology of the skin punch biopsy showed giant-cell granulomatous inflammation without necrosis. The patient was started on prednisone 40 mg daily with a steroid tapering course for 8 weeks.Conclusions:The management of IFN-induced sarcoidosis includes the discontinuation of IFN therapy with or without the administration of systemic corticosteroids. With the increasing prevalence of HCV in the United States, it is likely that more IFN-alpha-induced sarcoidosis will be encountered by clinicians.

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Interferon-induced granulomatous lung disease

Abstract: Interferon therapy can induce or exacerbate sarcoidosis, the disease disappears when interferon is discontinued, sometimes treatment with corticosteroids is required.

Cited by 38 publications

References 28 publications

Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Sarcoid reaction: a rare occurrence associated to colon adenocarcinoma (case report and literature review)

Interferon-alpha-associated presumed ocular sarcoidosis

Interferon-alpha-induced sarcoidosis in a patient being treated for hepatitis C

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