Chonnam Med J.  2014 Dec;50(3):115-118. 10.4068/cmj.2014.50.3.115.

Recurrent Pneumothorax after Etanercept Therapy in a Rheumatoid Arthritis Patient: A Case Report

• Kim SH
• Choi SJ
• Seo YH
• Kim JH
• Jeong IW
• Sohn SB

• KMID: 2172156
• DOI: http://doi.org/10.4068/cmj.2014.50.3.115

Abstract

The use of anti-tumor necrosis factor (anti-TNF) agents for rheumatoid arthritis (RA) patients who are refractory to disease-modifying anti-rheumatic drugs is gradually increasing. Etanercept is the first anti-TNF agent to be approved for RA treatment and is also the most widely used. However, aggravation of interstitial lung disease after etanercept treatment in RA patients has been reported recently. We report the first case of recurrent spontaneous pneumothorax with progression of interstitial lung disease after initiating etanercept therapy. The withdrawal of etanercept and a change to adalimumab, a different class of TNF inhibitor, achieved clinical stabilization.

Keyword

Lung diseases, interstitial; Pneumothorax; Arthritis, rheumatoid

MeSH Terms

Antirheumatic Agents
Arthritis, Rheumatoid*
Humans
Lung Diseases, Interstitial
Necrosis
Pneumothorax*
Adalimumab
Etanercept
Antirheumatic Agents

Figure

• 

  FIG. 1 Chest radiograph showing an absence of lung markings and a pleural line in the right chest, suggestive of spontaneous pneumothorax.

• 

  FIG. 2 (A) Baseline high-resolution computed tomography (HRCT) image of the chest. Mild subpleural interlobular septal thickening with ground glass attenuation is seen in both lungs. (B) HRCT image just after the initial onset of pneumothorax. Subpleural fibrosis and bronchiectasis worsened with a definite right-sided pneumothorax. (C) Follow-up HRCT on the same level of the chest. The image was taken after cessation of etanercept and 3 months after medication with adalimumab. One year after etanercept cessation, interstitial fibrosis is still noted but is relatively stable in its degree and extent.

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  FIG. 3 Chest radiograph showing right loculated pleural effusion.

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