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Park, Kim, Hwang, Lee, Paik, Jung, and Kim: A Case of Development of Sarcoidosis During Tumor Necrosis Factor-alpha Antagonist Therapy
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J Rheum Dis 2011;18(1):41-45.

Published online: 31 March 2011

DOI: https://doi.org/10.4078/jrd.2011.18.1.41

A Case of Development of Sarcoidosis During Tumor Necrosis Factor-alpha Antagonist Therapy

Soo Yuck Park1, Eun Kyoung Kim1, Deok Won Hwang1, Kang Won Lee1, Seung Sam Paik2, Kyong-Hee Jung1, 3, Tae-Hwan Kim1, 3

1Department of Internal Medicine, The Hospital for Rheumatic Diseases, Hanyang University College of Medicine, Seoul, Korea

2Department of Pathology, The Hospital for Rheumatic Diseases, Hanyang University College of Medicine, Seoul, Korea

3Department of Rheumatology, The Hospital for Rheumatic Diseases, Hanyang University College of Medicine, Seoul, Korea

Received 9 September 20108 October 2010       Accepted 10 October 2010

Copyright © 2011 The Korean College of Rheumatology

Abstract

Etanercept is a soluble receptor fusion protein that inhibits tumor necrosis factor-alpha(TNF-α). The receptor is used widely in the treatment of ankylosing spondylitis, rheumatoid arthritis, sarcoidosis and other indications. For sarcoidosis, it potentially suppresses granuloma formation with TNF-α blocking. On the other hand, recent studies have suggested that paradoxical sarcoidosis can be induced by TNF-α antagonists in some cases. A 42-year- old woman, who was treated with etanercept due to ankylosing spondylitis for 5 years, was admitted because of right suprahilar lymphadenopathy on chest radiography. Chest computed tomography revealed an enlargement of supraclavicular, paratracheal, mediastinal lymph nodes. She was diagnosed with sarcoidosis on the supraclavicular lymph node biopsy, which was noncaseating epithelioid cell granuloma and excluded from similar diseases. She was treated for sarcoidosis with prednisolone instead of etanercept.

Keywords: Tumor necrosis factor-α antagonist, Sarcoidosis, Ankylosing spondylitis

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Figure 1.
Pelvis AP shows the erosive changes and focal subchondral sclerosis of the bilateral sacroiliac joints, which is com-patible with sacroiliitis, grade 3.
jrd-18-41f1.tif
Figure 2.
Chest PA shows normal findings 4 months earlier (A) and right suprahilar lymph node (arrow) enlargement at a regular followup (B).
jrd-18-41f2.tif
Figure 3.
Chest CT scan showing right hilar, subcarinal lymphadenopathy (arrow head) (A) and left supraclavicular, right upper paratracheal lymphadenopathy (arrow) (B).
jrd-18-41f3.tif
Figure 4.
Supraclavicular lymph node biopsy showing evenly distributed small noncaseating granulomas (arrow) (A) (H&E stain, ×40) composed of epithelioid histiocytes (arrow) (B) (H&E stain, ×200).
jrd-18-41f4.tif
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