Sarcoid-like granulomatosis in patients treated with tumor necrosis factor blockers: 10 cases

Abstract

Sarcoid-like granulomatosis is rare but not exceptional in patients treated with TNF blockers (approximately 1/2800) and does not seem to be related to gender, rheumatic disease or in our series the type of anti-TNF drug used (monoclonal antibodies or soluble receptor). Discontinuation of anti-TNF usually leads to recovery.

Development of exclusively cutaneous sarcoidosis in patient with rheumatoid arthritis during treatment with etanercept

“…2 Diagnosis is based on clinical presentation and histopathological findings. 3 Tumor necrosis factor is produced by inflammatory cells such as macrophages, keratinocytes, and T helper 1 (Th1) lymphocytes. 4 It is implicated in the pathogenesis of granulomatous inflammatory diseases.…”

“…There is a positive correlation between TNF-α levels and sarcoidotic disease activity. 3,4 Thus, sarcoidosis would be effectively treated with TNF-α blockers. However, cases of cutaneous, pulmonary, and ocular sarcoidosis due to an unexpected and paradoxical effect of these medications have been reported.…”

“…However, cases of cutaneous, pulmonary, and ocular sarcoidosis due to an unexpected and paradoxical effect of these medications have been reported. 3,4 One of the hypotheses that have been reported is that the increased incidence of infections treated with anti-TNF-α could lead to the development of granulomas. 5 We report the case of a patient who developed sarcoidotic skin lesions during treatment with etanercept (ETN), without associated systemic manifestations.…”

Sarcoid-related Uveitis Occurring During Adalimumab Therapy

“…Daien et al estimated the frequency of this adverse event to be at least 0.04% (1/2800). 1 A study published last year found 28 cases, including 16 cases with etanercept, 8 cases under infliximab, and 4 with adalimumab. 2 The median delay between anti-TNFα agent introduction and granulomatosis diagnosis was 19 (range 1-60) months.…”

“…1 A recent literature review found 28 cases of proved granulomatosis in patients receiving anti-TNFα, 4 of whom had ocular involvement (including 3 cases with etanercept and 1 with infliximab). 2 Herein, we describe a patient with rheumatoid arthritis (RA) who developed chronic bilateral panuveitis and cutaneous nodule on the face, 5 years after administration of adalimumab.…”