Etanersept tedavisi altında gelişen paradoksal pulmoner sarkoidoz: Olgu sunumu ve literatürün gözden geçirilmesi

Öz

Tümör nekroz faktörü inhibitörü (TNFi) tedavileri günümüzde birçok romatizmal hastalıkta en önemli tedavi basamaklarından birini oluşturmaktadır. Bununla birlikte, bu ajanların kullanımının birçok paradoksal otoimmün hastalığın gelişimi ile ilişkili olduğu gösterilmiştir. Bu vaka sunumunda etanersept tedavisi altında paradoksal sarkoidoz gelişen hastayı güncel literatür eşliğinde tartışmayı amaçladık. Psöriatik artrit (PsA) tanısı ile 3 yıldır etanercept (50 mg/hafta subkutan) kullanan 40 yaşındaki erkek hastanın akciğer görüntülemesinde mediastinal lenfadenopati ve her iki akciğer alanında santral yerleşimli nodüller saptandı. Lenf bezi biopsi sonucu non kazeifiye granülomatöz inflamasyon saptandı. Asemptomatik paradoksal sarkoidoz olarak kabul edilen hastanın etanersept tedavisi sonlandırıldı. Hastanın 6. ay takibinde PsA klinik aktivite skorlarında artış saptandı. Bu nedenle hastaya İnterlökin 17A inhibitörü (anti-IL17A) olan sekükinumab tedavisi başlandı. Hastanın birinci yıl takibinde mediastinal lenf nodlarında tama yakın regresyon izlendi. TNFi tedavisi sırasında paradoksal sarkoidoz gelişen hastalarda mevcut TNFi tedavisinin kesilmesinin ve sekükinumab (anti-IL-17A) veya diğer TNFi tedavilere geçilmesinin uygun olacağını düşünmekteyiz.

Anahtar Kelimeler

• psöriatik artrit,etanersept,TNFi,anti-IL17A,sekükinumab,paradoksal sarkoidoz

PARADOXICAL PULMONARY SARCOIDOSIS UNDER ETANERCEPT TREATMENT: A CASE REPORT AND REVIEW OF THE LITERATURE

Öz

Tumor necrosis factor inhibitor (TNFi) therapies are currently one of the most important treatment options in rheumatic diseases. However, the use of these agents has been shown to be associated with the development of paradoxical autoimmune reactions. In this case report, we aimed to discuss the patient who developed paradoxical sarcoidosis under etanercept treatment in the light of current literature. Mediastinal lymphadenopathy and central located nodules in both lungs were detected in the 40-year-old male patient who had been using etanercept (50 mg/week subcutaneously) for 3 years with the diagnosis of psoriatic arthritis (PsA). Lymph node biopsy revealed non-caseified granulomatous inflammation. The patient was diagnosed as asymptomatic paradoxical sarcoidosis and etanercept treatment was stopped. PsA clinical activity scores of patient were increased during the 6th month follow-up. Therefore, secukinumab, interleukin 17A inhibitör (anti-IL17A), was started. Nearly complete regression of mediastinal lymph nodes was observed in the first year follow-up of the patient. We think that the discontinuation of TNFi treatment and secukinumab (anti-IL17A) or other TNFi agents can be used safely in patients who develop paradoxical sarcoidosis during TNFi treatments.

Anahtar Kelimeler

• psoriatic arthritis,etanercept,TNFi,anti-IL17A,secukinumab,paradoxical sarcoidosis

Kaynakça

1. Cuchacovich R, Hagan J, Khan T, Richert A, Espinoza LR. Tumor necrosis factor-alpha (TNF-α)-blockade-induced hepatic sarcoidosis in psoriatic arthritis (PsA): case report and review of the literature. Clin Rheumatol. 2011;30(1):133–7.
2. Ziegenhagen MW, Muller-Quernheim J. The cytokine network in sarcoidosis and its clinical relevance. J Intern Med. 2003;253(1):18–30.
3. Daien CI, Monnier A, Claudepierre P, Constantin A, Eschard J-P, Houvenagel E, et al. Sarcoid-like granulomatosis in patients treated with tumor necrosis factor blockers: 10 cases. Rheumatology. 2009;48(8):883–6.
4. Massara A, Cavazzini L, La Corte R, Trotta F. Sarcoidosis Appearing During Anti-Tumor Necrosis Factor α Therapy: A New “Class Effect” Paradoxical Phenomenon. Two Case Reports and Literature Review. Semin Arthritis Rheum. 2010;39(4):313–9.
5. Mengi G. A Rare Adverse Effect of Anti-Tumor Necrosis Factor Alpha Therapy: Sarcoidosis. Arch Rheumatol. 2017;32(1):67–70.
6. Haraoui B. Differentiating the efficacy of the tumor necrosis factor inhibitors. Semin Arthritis Rheum. 2005;34(5):7–11.
7. Dogra S, Khullar G. Tumor necrosis factor-α antagonists: Side effects and their management. Indian J Dermatology, Venereol Leprol. 2013; 79(7):35.
8. Utz JP, Limper AH, Kalra S, Specks U, Scott JP, Vuk-Pavlovic Z, et al. Etanercept for the Treatment of Stage II and III Progressive Pulmonary Sarcoidosis. Chest. 2003;124(1):177–85.

9. Jamilloux Y, Cohen-Aubart F, Chapelon-Abric C, Maucort-Boulch D, Marquet A, Pérard L, et al. Efficacy and safety of tumor necrosis factor antagonists in refractory sarcoidosis: A multicenter study of 132 patients. Semin Arthritis Rheum. 2017;47(2):288–94.
10. Massara A, Cavazzini L, La Corte R, Trotta F. Sarcoidosis Appearing During Anti-Tumor Necrosis Factor (alpha) Therapy: A New “Class Effect” Paradoxical Phenomenon. Two Case Reports and Literature Review. Semin Arthritis Rheum. 2010; 39(4): 313-9.
11. Cleynen I, Vermeire S. Paradoxical inflammation induced by anti-TNF agents in patients with IBD. Nat Rev Gastroenterol Hepatol. 2012;9(9):496–503.
12. Conrad C, Di Domizio J, Mylonas A, Belkhodja C, Demaria O, Navarini AA, et al. TNF blockade induces a dysregulated type I interferon response without autoimmunity in paradoxical psoriasis. Nat Commun. 2018;9(1):25.
13. Roux CH, Brocq O, Leccia N, Giacchero D, Breuil V, Albert C, et al. New-onset psoriatic palmoplantaris pustulosis following infliximab therapy: a class effect? J Rheumatol. 2007; 34(2):434–7.
14. Toussirot É, Aubin F. Paradoxical reactions under TNF-α blocking agents and other biological agents given for chronic immune-mediated diseases: an analytical and comprehensive overview. RMD open. 2016;2(2):e000239.
15. Majjad A, Bezza A, Biyi A, El Ochi MR, El Maghraoui A. Pulmonary Sarcoidosis following Etanercept Treatment for Ankylosing Spondylitis: A Case Report and Review of the Literature. Vol. 2018, Case reports in rheumatology. 2018. p. 9867248.
16. Farah RE, Shay MD. Pulmonary sarcoidosis associated with etanercept therapy. Pharmacotherapy. 2007;27(10):1446–8.
17. Cole P, Rabasseda X. The soluble tumor necrosis factor receptor etanercept: a new strategy for the treatment of autoimmune rheumatic disease. Drugs Today (Barc). 2004;40(4):281–324.
18. Sweiss NJ, Zhang W, Franek BS, Kariuki SN, Moller DR, Patterson KC, et al. Linkage of Type I Interferon Activity and TNF-Alpha Levels in Serum with Sarcoidosis Manifestations and Ancestry. PLoS One. 2011;6(12):1–7.
19. Louie GH, Chitkara P, Ward MM. Relapse of sarcoidosis upon treatment with etanercept. Ann Rheum Dis. 2008; 67(6):896–8.
20. Özyilmaz E, Guzelbaba B, Durmaz A, Orhan G, Sarar G, Gokcen N, et al. The frequency of etarnecept related sarcoidosis. Eur Respir J. 2017;50(suppl 61):PA3267.
21. Baha A, Hanazay C, Kokturk N, Turktas H. A Case of Sarcoidosis Associated With Anti-Tumor Necrosis Factor Treatment. J Investig Med High Impact Case Rep. 2015;3(1):2324709615571366.
22. Toussirot E, Bernard C, Bossert M. Safety of the use of anti-IL17A treatment in a patient with certolizumab-induced sarcoidosis. Clin Exp Rheumatol. 2019;37(2):344–5.
23. Kammüller M, Tsai T-F, Griffiths CE, Kapoor N, Kolattukudy PE, Brees D, et al. Inhibition of IL-17A by secukinumab shows no evidence of increased Mycobacterium tuberculosis infections. Clin Transl Immunol. 2017;6(8):e152.