J Rheum Dis.  2016 Jun;23(3):187-192. 10.4078/jrd.2016.23.3.187.

A Case of Sarcoidosis That Improved upon Discontinuation of Etanercept

• Kang JH
• Ahn JH
• Yu JE
• Kim JE
• Yim YR
• Lee JW
• Lee KE
• Park DJ
• Wen L
• Park YW
• Lee SS

• KMID: 2326735
• DOI: http://doi.org/10.4078/jrd.2016.23.3.187

Abstract

A 31-year-old man who had been prescribed etanercept over a 3-year period for treatment of ankylosing spondylitis presented with newly developed dry cough, chills, myalgia, and weight loss. Chest computed tomography showed multiple reticulonodular pulmonary infiltrates and bilateral mediastinal, hilar, and peribronchial lymphadenopathy. Biopsy of a paratracheal lymph node revealed chronic granulomatous inflammation without necrosis, and the serum angiotensin-converting enzyme level was elevated. Sarcoidosis was diagnosed. His laboratory and radiological findings, and clinical symptoms improved only after discontinuation of etanercept without treatment. Although etanercept-induced sarcoidosis is rare, this case report suggests that sarcoidosis should be considered in the differential diagnosis of patients treated with the tumor necrosis factor inhibitor.

Keyword

Etanercept; Sarcoidosis; Ankylosing spondylitis

MeSH Terms

Adult
Biopsy
Chills
Cough
Diagnosis, Differential
Etanercept*
Humans
Inflammation
Lymph Nodes
Lymphatic Diseases
Myalgia
Necrosis
Sarcoidosis*
Spondylitis, Ankylosing
Thorax
Tumor Necrosis Factor-alpha
Weight Loss
Etanercept
Tumor Necrosis Factor-alpha

Figure

• 

  Figure 1. Radiographic images. (A) Before etanercept treatment, (B) after treatment, (C) after discontinuation of etanercept.

• 

  Figure 2. (A) Chest computed tomography scan exhibit multiple ground-glass opacities (white arrow) and mediastinal and hilar lymphadenopathy (black arrow).(B) Six months after discontinuation of etanercept, the radiological findings had improved.

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  Figure 3. The right paratracheal lymph node exhibits chronic granulomatous inflammation without necrosis, suggestive of sarcoidosis (H&E; A: ×100, B: ×200).

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