Reactions 1680, p17 - 2 Dec 2017 Sarcoidosis-like lesions (a paradoxical reaction to anti-tumour necrosis factor) and uveitis: 2 case reports In a case series, a 30-year-old man developed sarcoidosis like lesions and uveitis during treatment with adalimumab, and a 21-year-old man developed sarcoidosis like lesions during treatment with adalimumab and infliximab [dosages and routes not stated]. Case 1: A 30-year-old man, who had been diagnosed with Crohn’s disease (CD) at the age of 17, was started on infliximab; however, the drug was stopped due to a paradoxical psoriasiform reaction. Three months later, he was started on adalimumab for a serious CD relapse. After more than five years of treatment, he developed a bilateral intermediate uveitis with an anterior component. Differential diagnosis included an infection, CD-related uveitis and adalimumab-induced uveitis. Adalimumab was stopped. Five months later, he presented with significant weight loss, fatigue, increased stool frequency and urgency. A CT scan of chest and abdomen revealed bilateral mediastinal and hilar lymphadenopathies, as well as multiple nodular lung lesions, an enlarged spleen and multiple mesenterial lymphadenopathies. Blood analysis revealed a C-reactive protein of 15 mg/L and an angiotensin-converting enzyme of 78 U/L. Histology revealed non-necrotising granulomas. Positron emission tomography combined with CT-scan revealed hypermetabolic lung lesions, multiple lymphadenopathies and elevated tracer uptake in rectum and sigmoid. Finally, he was diagnosed with a novel onset sarcoidosis in combination with active CD. He was treated with methylprednisolone. Two months later, his condition improved. Case 2: A 21-year-old man, who had been diagnosed with CD at the age of 10, was started on treatment with infliximab for 6 years. Later, the therapy was switched to adalimumab due to a delayed hypersensitivity reaction. Eighteen months later, he presented with a nodular skin lesion. Biopsy showed a non-caseating granulomatous inflammatory process. A chest X-ray showed hilar lymphadenopathies. High-resolution CT confirmed above findings and showed mediastinal lymphadenopathies and multiple small nodules. Laboratory analysis showed elevation of ACE. Therefore, adalimumab was stopped. Serum analysis did not detect adalimumab. Finally, he was diagnosed with sarcoidosis-like lesions. Therefore, he was treated with topical steroids and hydroxychloroquine. Four months after corrective treatment, he showed a deterioration of lung function tests. Furthermore, magnetic resonance imaging suggested cardiac involvement. He was treated with high doses methylprednisolone. After one month, an improvement was noted in cutaneous lesions and lung function test results. Author comment: "We reported two cases of sarcoidosis- like lesions, which developed during or shortly after [anti- tumour necrosis factor] treatment for CD. The development of sarcoidosis-like lesions during anti-TNF therapy can be seen as paradoxical since some anti-TNF agents are also used in refractory sarcoidosis" Decock A, et al. Sarcoidosis-Like Lesions: Another Paradoxical Reaction to Anti- TNF Therapy?. [Review]. Journal of Crohn’s and Colitis 11: 378-383, No. 3, 30 Sep 2016. Available from: URL: https://doi.org/10.1093/ecco-jcc/jjw155 - Belgium 803284688 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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