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Respir Med Case Rep. 2013 Oct 26;10:53-5. doi: 10.1016/j.rmcr.2013.07.002. eCollection 2013.

Adalimumab induced pulmonary sarcoid reaction.

Respiratory medicine case reports

S Bhargava, D M Perlman, T L Allen, J H Ritter, M Bhargava

Affiliations

  1. Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
  2. Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA.
  3. Department of Pathology, University of Minnesota Medical School, Minneapolis, MN, USA.

PMID: 26029514 PMCID: PMC3920421 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.

Keywords: Adalimumab; Sarcoid reaction; TNF blockers

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