Tuberc Respir Dis.  2011 Dec;71(6):464-469.

Sarcoidosis Induced by Adalimumab in Rheumatoid Arthritis

• Lee SH
• Kim SI
• Song JS
• Kim TH
• Sohn JW
• Kim SH
• Yoon HJ
• Kim TH
• Shin DH
• Park SS
• Kwak HJ

Abstract

Adalimumab is a full human monoclonal antibody that inhibits tumor necrosis factor-alpha (TNF-alpha). This has recently been shown to be effective in the treatment of rheumatoid arthritis (RA), ankylosing spondylitis, and other conditions. Sacoidosis is known to be the target for adalimumab but we describe a patient who has developed sarcoidosis with lung involvement during adalimumab therapy for RA. A 48-year-old woman, who was treated with adalimumab for 5 months, was admitted because of chronic cough and both hilar lymphadenopathy on chest radiography. Chest computed tomography revealed the enlargement of multiple lymph nodes in the right supraclavicular, subcarinal, both hilar and right axillary area. She was diagnosed with sarcoidosis based on the biopsy of supraclavicular lymph node, skin and lung through video-associated thoracoscopic surgery, which was non-caseating epitheloid cell granuloma and excluded from a similar disease. She was treated for sarcoidosis with prednisolone and methotrexate instead of adalimumab.

Keyword

Tumor Necrosis Factor-alpha; Antibodies, Monoclonal, Humanized; Sarcoidosis; Arthritis, Rheumatoid

MeSH Terms

Antibodies, Monoclonal, Humanized
Arthritis, Rheumatoid
Biopsy
Cough
Female
Granuloma
Humans
Lung
Lymph Nodes
Lymphatic Diseases
Methotrexate
Middle Aged
Prednisolone
Sarcoidosis
Skin
Spondylitis, Ankylosing
Thoracoscopy
Thorax
Tumor Necrosis Factor-alpha
Adalimumab
Antibodies, Monoclonal, Humanized
Methotrexate
Prednisolone
Tumor Necrosis Factor-alpha

Figure

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  Figure 1 Photography of skin lesions. Face (A) and inguinal area (B). There were localized erythematous papules (arrow).

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  Figure 2 Simple chest radiography. Chest X-ray shows normal findings 6 months earlier (A) and both hilar lymph node (arrows) enlargement at a regular follow-up (B).

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  Figure 3 Chest CT scans show both hilar, subcarinal lymphadenopathy and right upper paratracheal lymphadenopathy (arrow). CT: computed tomography.

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  Figure 4 Supraclavicular lymph node and lung biopsy showing evenly distributed small non caseating granulomas (A) Supraclavicular lymph node biopsy (H&E stain ×200). (B) Lung biopsy (H&E stain ×100). (C) Lung biopsy (H&E stain ×200).

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  Figure 5 Simple chest radiography after treatment with systemic corticosteroid and MTX. Chest X-ray shows improvement in the hilar lymphadenopathy and peripheral infiltrates.

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