CASE REPORT - Pulmonary sarcoidosis associated with Enbrel therapy

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Pharmacotherapy. 2007 Oct;27(10):1446-8.

Pulmonary sarcoidosis associated with etanercept therapy.

Farah RE, Shay MD.

Department of Internal Medicine F, Western Galilee Hospital, Nahariya, Israel.

We present a case of probable pulmonary sarcoidosis associated with

the use of etanercept for psoriatic arthritis. Other cases of

etanercept-induced granulomas and skin sarcoidosis were recently

published in the medical literature, but we found only one case that

involved lung sarcoidosis during etanercept therapy. We describe a

40-year-old man who was receiving etanercept for severe psoriatic

arthritis and was admitted to the hospital with dyspnea and subfebrile

illness several months after the start of treatment. His diagnosis was

consistent exclusively with sarcoidosis. The patient's symptoms

improved when etanercept was discontinued, but they did not resolve

completely. Treatment with prednisone 40 mg led to complete

improvement of his pulmonary disease. Etanercept therapy can induce or

exacerbate sarcoidosis. The disease disappears when etanercept is

discontinued, although treatment with corticosteroids is sometimes

required, as in our patient. Use of the Naranjo adverse drug reaction

probability scale revealed a probable likelihood (score of 6) that the

adverse reaction was related to etanercept. The association of

etanercept with sarcoidosis is still a rare finding. This case

highlights the importance of monitoring and possibly discontinuing the

drug when sarcoidosis is suspected. Patients should be monitored

during and after etanercept therapy for manifestations suggesting

sarcoidosis, and we recommend patients receive baseline chest

radiography at the start of therapy with follow-up of respiratory

symptoms.

PMID: 17896899

http://www.ncbi.nlm.nih.gov/pubmed/17896899

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