Lung and liver sarcoidosis‐like reaction induced by tocilizumab

Abstract

A drug‐induced sarcoidosis‐like reaction is a systemic granulomatous reaction indistinguishable from sarcoidosis and occurring in temporal relationship with a drug initiation. In this article, we report a patient who developed lung and liver granulomatous lesions following tocilizumab initiation for a giant cell arteritis. Infectious, toxic, neoplastic and inflammatory differential diagnoses were ruled out and lesions regressed after treatment cessation, leading to the diagnosis of tocilizumab induced sarcoidosis‐like reaction. We review the 6 cases reported so far and emphasize the value of a prompt diagnosis. Finally, we discuss the potential pathophysiological mechanisms underlying this rare reaction, which could help to better understand the pathophysiology of sarcoidosis.

Harnessing Biomaterials for Safeguarding Chimeric Antigen Receptor T Cell Therapy: An Artful Expedition in Mitigating Adverse Effects

“…Severe ICANS is typically managed with corticosteroid therapy, while tocilizumab has shown limited efficacy in the majority of ICANS cases [ 50 ]. However, the use of tocilizumab has also raised concerns about adverse drug reactions, such as lung and liver sarcoidosis [ 51 ]. Corticosteroids, on the one hand, mediate broad anti-inflammatory and immunosuppressive effects but concurrently inhibit the proliferation of CAR-T cells and the secretion of effector cytokines.…”

Molecularly Targeted Therapies for Inflammatory Cutaneous Granulomatous Disorders: A Review of the Evidence and Implications for Understanding Disease Pathogenesis

“…Another case report described the use of tocilizumab in a patient with Blau syndrome ( Lu et al., 2018 ). Interestingly, there are multiple instances in the literature describing the development of sarcoidosis or sarcoidosis-like disease in patients receiving IL-6 inhibitors, including tocilizumab ( Lambert et al., 2021 ; Theodosiou et al., 2020 ).…”

Drug-induced sarcoidosis-like reactions

“…Less reported drug categories associated with DISR frequently target different parts of the immune system, such as anti-CD20 (Rituximab) [19], anti-CD25 (Daclizumab) [20], anti IL6 (Tocilizumab) [21] and anti-L12/23 (ustekinumab) [22]. In a cohort with DISR patients on treatment for melanoma with ICI or BRAF/MEK inhibitors, the majority of patients on BRAF/MEK inhibitors had a granulomatous skin lesion and no pulmonary or lymph node involvement [10 ▪ ].…”