Development of sarcoidosis during etanercept therapy
Development of sarcoidosis during etanercept therapy
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DOI：
10.2169/internalmedicine.47.0602
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发表时间：
2008-01-01
影响因子：
1.2
通讯作者：
Kawabata, Yoshinori
中科院分区：
文献类型：
--
作者：
Ishiguro, Takashi;Takayanagi, Noboru;Kawabata, Yoshinori
这份报告描述了一位65岁的女性，在依那西普治疗类风湿性关节炎的过程中，出现了与结节病一致的肉芽肿性皮损。服用依那西普21个月后，两个肺野出现肺门和纵隔淋巴结肿大和多发结节。非干酪性上皮样肉芽肿与结节病一致，可在肺活检标本和开胸取自壁胸膜中检测到。排除有相似组织学改变的疾病，并诊断为结节病。停用依那西普，症状缓解，氧合改善，放射学结果。有大量证据表明，肿瘤坏死因子-α参与了肉芽肿形成的诱导和维持；然而，我们应该记住，肉芽肿性疾病，如结节病，可以在使用肿瘤坏死因子-α阻滞剂(如依那西普)治疗期间发生。
This report describes a 65-year-old woman who developed granulomatous lesions consistent with sarcoidosis during etanercept therapy for rheumatoid arthritis. Hilar and mediastinal lymphadenopathy and multiple nodules in both lung fields developed 21 months after administration of etanercept. Noncaseating epithelioid cell granulomas consistent with sarcoidosis were detected in a lung biopsy specimen and in the parietal pleura obtained via thoracotomy. Diseases showing similar histologic changes were excluded, and a diagnosis of sarcoidosis was made. Etanercept was discontinued, which resulted in symptomatic relief, improvement of oxygenation and radiologic findings. There is substantial evidence of tumor necrosis factor-alpha involvement in the induction and maintenance of granuloma formation; however, we should keep in mind that granulomatous disease, such as sarcoidosis, can develop during treatment with a tumor necrosis factor-alpha blocking agent, such as etanercept.