Adalimumab induced pulmonary sarcoid reaction

• Published in: Respiratory medicine case reports Vol. 10; pp. 53 - 55
• Main Authors: Bhargava, S, Perlman, D.M, Allen, T.L, Ritter, J.H, Bhargava, M
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2013; Elsevier
• Subjects: Adalimumab; Case Report; Internal Medicine; Pulmonary/Respiratory; Sarcoid reaction; TNF blockers; Sarcoid reaction; Adalimumab; TNF blockers
• ISSN: 2213-0071; 2213-0071
• DOI: 10.1016/j.rmcr.2013.07.002

Abstract Sarcoidosis is a multisystem granulomatous inflammatory disease of unknown etiology. There is evidence that Tumor Necrosis Factor alpha (TNF-α) antagonists are useful in the treatment of advanced or refractory disease. However, sarcoidosis-like reaction has been reported with TNF-α blockade in other inflammatory conditions. Here we report a case of sarcoid-like reaction in a patient with psoriatic arthritis shortly after initiation of adalimumab therapy. Stopping adalimumab and systemic anti-inflammatory therapy with corticosteroids resulted in resolution of pulmonary symptoms and chest radiographic findings. Though TNF-α plays a critical role in pathogenesis of sarcoidosis, the development of sarcoid reaction with TNF-α blockade is paradoxical and the mechanism of this response remains unknown. TNF-α induced sarcoid-reaction could involve multiple organs. Its development with one agent does not preclude therapy with other TNF-α blockers.