Abstract:We report the case of a patient with rheumatoid arthritis who, after 2 months of treatment with etanercept, showed disseminated asymptomatic violaceous papules. Biopsy of the skin lesion showed chronic granulomatous dermatitis with negative staining for fungi and acid-fast bacilli (AFB). After discontinuation of etanercept, the patient's condition improved. Although apparently paradoxical, cases of cutaneous and systemic sarcoidosis after anti-TNF medications have been reported in the literature, with very few… Show more
“…Biopsy of the skin lesion showed chronic granulomatous dermatitis with negative staining for fungi and acid-fast bacilli (AFB). The lesions improved once etanercept was discontinued [17]. Over the years, similar observations are being reported in literature with significance.…”
Patients treated with biologic drugs for various-not only dermatological-diseases are growing in number. Biologic drugs applied as a long-term therapy of psoriasis are safe, enable disease remission, and most importantly, help improve the patient's quality of life. It is also crucial to note, that biologic agents decrease patient mortality rate. Much research has shown the unquestionable efficiency of biologic therapies despite their also well-documented rare adverse effects. Due to the growing range of application of these agents, it is critical to keep an observant eye during the monitoring of the patient in case of new disease activity. This study aims to present the case of a female patient treated with etanercept for severe psoriasis arthritis (PsA) who subsequently developed acute sarcoidosis and to examine the risk of serious adverse events.
“…Biopsy of the skin lesion showed chronic granulomatous dermatitis with negative staining for fungi and acid-fast bacilli (AFB). The lesions improved once etanercept was discontinued [17]. Over the years, similar observations are being reported in literature with significance.…”
Patients treated with biologic drugs for various-not only dermatological-diseases are growing in number. Biologic drugs applied as a long-term therapy of psoriasis are safe, enable disease remission, and most importantly, help improve the patient's quality of life. It is also crucial to note, that biologic agents decrease patient mortality rate. Much research has shown the unquestionable efficiency of biologic therapies despite their also well-documented rare adverse effects. Due to the growing range of application of these agents, it is critical to keep an observant eye during the monitoring of the patient in case of new disease activity. This study aims to present the case of a female patient treated with etanercept for severe psoriasis arthritis (PsA) who subsequently developed acute sarcoidosis and to examine the risk of serious adverse events.
“…Immune checkpoint inhibitors can induce sarcoidosis by modifying cytotoxic, Th1/17 and regulatory T-cell ratios 10, 21Table IDrugs that induce cutaneous sarcoidosis and proposed biologic mechanisms of inductionDrugBiologic mechanismIL-1Ra: anakinra 1 Unopposed type I IFN productionFailure of immune regulatory mechanismsImmunosuppression favoring infection with bacterium implicated in sarcoidosisInterferon-α 3 Induction of Th1 cytokinesanti-TNF agents4, 5: entanercept, 6 infliximab, 7 adalimumab 8 Unopposed type I IFN productionMove toward a Th1/Th17 profileDecreased TNF-mediated suppression of Treg expansion/activityAlteration in ratio of membrane bound to soluble TNFR2Process of anti-IFX antibody productionPredisposition secondary to genetic variation of TNF-α genePD-1 inhibitors: pembrolizumab, 9 nivolumab 10 Increased T-cell proliferative capacityNote: PD-1 up-regulation has also been associated with sarcoidosis with a proposed mechanism of decreased T-cell proliferative capacity leading to immunologic derangements conducive to sarcoidosis BRAF inhibitor: vemurafenib 11 Increased TNF-α and IFN-γ levelsNote: Study suggests patients who have sarcoidosis with vemurafenib therapy carry a better prognosisanti-CTLA4 mAb: ipilimumab 12 Enhanced T-cell responsesanti-IgE mAb: omalizumab 13 Decreased expression of dendritic cell IgE high affinity receptor/Th2 cytokine production with subsequent shift from Th2 to Th1 cytokine profileUnmasking of sarcoidosis with prednisone taper accompanying omalizumab treatment initiationFillers for aesthetic procedures: hyaluronic acid 14 Tissue injury and foreign body reaction to fillerInsulin15, 16Traumatic induction (Koebnerization) and foreign body reaction to materials introduced with insulin injectionInflammatory response to zinc component of insulin formulationBotulinum neurotoxin A 17 Foreign body reaction after deposition of crystalline preparation of botulinum neurotoxin A in the skinForeign body reactio...…”
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.