ANKILOZAN SPONDİLİT NEDENİYLE ETANERCEPT KULLANIMINA BAĞLI SARKOİDOZ OLGUSU

Öz

TNF-alfa blokerlerinden olan etanercept tedavisi altında ortaya çıkan ve mediastinoskopi ile tanı koyduğumuz sarkoidoz olgumuzu literatür bilgileri ışığında irdelemeyi amaçladık. Ankilozan spondilit tanısı ile etanercept tedavisi alan 31 yaşındaki erkek hasta tedavinin beşinci yılında başlayan ses kısıklığı ve yutma güçlüğü yakınması ile kliniğimizde başvurdu. Toraksın bilgisayarlı tomografisinde bilateral multipl mediastinal ve hiler lenfadenopati saptanan bu olguda mediastinoskopik biyopsi materyalinin histopatolojik incelemesinde kazeifikasyon göstermeyen granüloma formasyonunun görülmesi ve tüberküloz gibi diğer granülomatöz hastalıkların ekarte edilmesi ile sarkoidoz tanısı konuldu. Sistemik steroid tedavisi başlanan olguda klinik ve radyolojik iyileşme sağlandı. Steroide direçli sarkoidoz olgularının tedavisinde de kullanılan TNF-alfa blokerlerinin yol açtığı sarkoidoz son yıllarda bildirilen yeni bir yan etkidir ve sarkoidoz ile TNF-alfa blokerleri arasındaki bu ilişki paradoksal bir durum olarak tanımlanmaktadır.

Anahtar Kelimeler

• Ankilozan spondilit, anti TNF-α, etanersept, sarkoidoz

A SARCOIDOSIS CASE ASSOCIATED WITH THE USE OF ETANERCEPT BECAUSE OF ANKYLOSING SPONDYLITIS

Abstract

We aimed to discuss under the light of literature, the sarcoidosis case diagnosed by mediastinoscopy under the treatment of etanercept which is one of the TNF-alpha blockers. A 31 year-old male patient, taking etanercept treatment because of ankylosing spondylitis admitted to our clinic with the complaints of cough, hoarseness and dysphagia at the fifth year of etanercept treatment. Bilateral, multiple mediastinal-hilar lymphadenopathy were detected in thoracic computerized tomography, diagnosis of sarcoidosis was established by seeing non-caseating granuloma formation in histopathological examination of mediastinoscopic biopsy and ruling out the other granulomatous diseases such as tuberculosis. Clinical and radiological improvement was provided by systemic steroid treatment. Sarcoidosis caused by TNF-alpha blockers that are also used in treatment of sarcoidosis resistant to steroid is a new side effect and this relationship between the sarcoidosis and TNF-alpha blockers are defined as paradoxal situation.

Keywords

• Ankylosing spondylitis, anti TNF-α,etanercept, sarcoidosis

Kaynakça

1. 1. Massara A, Cavazzini L, Corte RL, 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; 39:313-9.
2. 2. Haroon M, Ryan JG, Harney S. Development of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association. Clin Rheumatol 2011; 30:1095-8.
3. 3. Takahashi H, Kaneta K, Honma M, et al. Sarcoidosis during infliximab therapy for Chron’s disease. Journal of Dermatology 2010; 37:471-4.
4. 4. Skoie IM, Wildhagen K, Omdal R. Development of sarcoidosis following etanercept treatment: a report of three cases. Rheumatol Int 2012; 32:1049-53.
5. 5. Clementine RR, Lyman J, Zakem J, Mallepalli J, Lindsey S, Quinet R. Tumor necrosis factoralpha antagonisinduced sarcoidosis. J Clin Rheumatol 2010; 16:274-9.
6. 6. Ishıguro T, Takayanagi N, Kurashima K, et al. Development of sarcoidosis during etanercept therapy. Inter Med 2008; 47:1021-5.
7. 7. Hashkes PJ, Shajrawi I. Sarcoid-related uveitis occuring during etanercept therapy. Clinical and Experimental Rheumatology 2003; 21:645-6.
8. 8. Dhaille F, Viseux V, Caudron A, et al. Cutaneous sarcoidosis occuring during anti-TNF-alpha treatment: Report of two cases. Dermatology 2010; 220:234-7.

9. 9. Verschueren K, Essche EV, Verschueren P, Taelman V, Westhovens R. Development od sarcoidosis in etanercept induced rheumatoid arthritis patiens. Clin Rheumatol 2007; 26: 1969-71.
10. 10. Scallon B, Cai A, Solowski N, et al. Binding and functional comparisons of two types of tumor factor antagonists. J Pharmacol Exp Ther 2002; 301:418-26.
11. 11. Shigehara K, Shijubo N, Ohmichi M et al. IL-12 and IL-18 are increased and stimulate IFNgamma production in sarcoid lungs. J immunol 2001; 166:642.
12. 12. Daien CI, Monnier A, Claudepierre P, et al. For the Club Rhumatismes et Inflammation (CRI). Sarcoid-like granulomatosis in patients treated with tumor necrosis factor blockers: 10 cases. Rheumatology 2009; 48:883-6.
13. 13. Raymond E, Farah MD, Moshe D, Shay MD. Pulmonary sarkoidosis associated with etanercept therapy. Pharmacotherapy 2007; 27: 1446-8.
14. 14. Cuchacovich R, Hagan J, Khan T, Richert A, Espinoza RL. Tumor necrosis factor-alpha (TNFα)-blocade-induced hepatic sarcoidosis in psoriatic arthritis (PsA): case report and review of the literature. Clin Rheumatol 2011; 30:133-7.