Two Cases of Interferon-Alpha-Induced Sarcoidosis Koebnerized along Venous Drainage Lines: New Pathogenic Insights and Review of the Literature of Interferon-Induced Sarcoidosis

Abstract

Sarcoidosis is a systemic granulomatous disorder of unknown origin commonly affecting the lung, the lymphoid system and the skin. We report here two cases of cutaneous sarcoidosis in two former intravenous drug users following interferon (IFN)-α and ribavirin therapy for chronic hepatitis C. Both patients developed skin sarcoidosis along venous drainage lines of both forearms, coinciding with the areas of prior drug injections. The unique distribution of the skin lesions suggests that tissue damage induced by repeated percutaneous drug injections represents a trigger for the local skin manifestation of sarcoidosis. Interestingly, skin damage was recently found to induce the local expression IFN-α, a well-known trigger of sarcoidosis in predisposed individuals. Here we review the literature on sarcoidosis elicited in the context of IFN-α therapy and propose a new link between the endogenous expression of IFN-α and the induction of disease manifestations in injured skin.

Development of exclusively cutaneous sarcoidosis in patient with rheumatoid arthritis during treatment with etanercept

“…1 It commonly affects the lungs, lymphoid system, and skin. 2 Diagnosis is based on clinical presentation and histopathological findings. 3 Tumor necrosis factor is produced by inflammatory cells such as macrophages, keratinocytes, and T helper 1 (Th1) lymphocytes.…”

Efficacy and HCC development after DAA therapy for patients with chronic hepatitis C: a single center retrospective cohort study

“…So, IFN therapy activated immune systems that help to eradicate HCV. The previous report indicated that IFN therapy for CHC triggered sarcoidosis via activating immune system [9][10][11] . Sarcoidosis is a granulomatous autoimmune disease of unknown etiology that may affect many organs.…”

Granulomatous Drug Eruptions

“…54 In the cases of IFN-a-induced sarcoidosis koebnerized along venous drainage lines in former intravenous drug users, it was suggested that repeated venipuncture over several years resulted in tissue injury, chronic subclinical inflammation, and scar formation, which koebnerized the cutaneous sarcoidosis. 55 Sarcoidosis has been effectively treated with TNF-a blockers, owing to the important role of TNF-a in granuloma formation and maintenance. 56 However, there have also been case reports of an unexpected, paradoxic effect of the development of sarcoidosis in patients on anti-TNF-a therapy.…”

“…Interferon-a a, 54,55,63,65 Anti-TNF agents: etanercept, infliximab, adalimumab 57,58,60 Synthetic fillers used for cosmetic procedures (hyaluronic acid) 64 Zinc 80…”

“…In 4 patients, cutaneous lesions appeared adjacent to older scars or tattoos. In the 2 cases of IFN-a-induced sarcoidosis koebnerized along venous drainage lines, 55 painless, firm, erythematous skin papules developed in a linear distribution along the cephalic and median antebrachial veins of both forearms in former areas of drug injections. The cases were reported in 2 former intravenous drug users following 16 and 30 weeks of treatment with IFN-a and ribavirin for chronic hepatitis C. 55 In a case report of hyaluronic acid injections inducing cutaneous sarcoidosis, tender nodules in both nasolabial folds that had developed 4 months after the injection of hyaluronic acid for wrinkles were described.…”