Etanercept
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Sarcoidosis: case report A 52-year-old woman, with a long-term history of rheumatoid arthritis, developed sarcoidosis during treatment with etanercept. The woman, who had received several antirheumatic agents and had started treatment with leflunomide in 2000, had etanercept 25 mg/week added to her treatment regimen in January 2007; her etanercept dosage was increased to 50 mg/week in July 2007. In March 2008, she suddenly developed general malaise and a fever of 38.5°C, and was hospitalised. She experienced pitting oedema bilaterally in her pedal and pretibial regions, and pruritus of the skin on both of her thighs. Tests revealed the following; haemoglobin 11.4 g/dL, CRP 10.93 mg/dL, AST 53 mU/mL, ALT 46 mU/mL, ALP 983 mU/mL, creatinine 0.4 mg/dL. A chest x-ray and CT scan showed lymph node involvement in her pulmonary hilar regions and mediastinum, and gallium scintigraphy revealed abnormal uptake in her paratracheal region, salivary glands and right quadriceps muscle. MRI also showed high intensity at her right quadriceps muscle. She experienced a worsening in her pruritus. Sarcoidosis was suspected and further test results were as follows; ACE 31.5 mU/mL, lysozyme 27.2 µg/mL, soluble interleukin-2 receptor 4830 U/mL, interferon-γ 0.9 IU/mL, osteopontin 327 ng/mL (her osteopontin level had started to increase in November 2007). Noncaseating granulomata with giant cells and lymphocyte infiltration were identified in biopsies from her liver and from the most pruritic region of her skin. The woman was diagnosed with sarcoidosis. Following the discontinuation of etanercept and leflunomide, she was treated with prednisone. Her symptoms rapidly improved and her ACE, soluble interleukin-2 receptor and interferon-γ levels normalised. Author comment: "A slight increase in plasma osteopontin level just before steep increases in other variables might deserve attention; osteopontin may portend the development of sarcoidosis and therefore could be important in pathogenicity." Takatori S., et al. Abrupt development of sarcoidosis with a prodromal increase in plasma osteopontin in a patient with rheumatoid arthritis during treatment with etanercept. The Journal of Rheumatology 37: 210-211, No. 1, 1 Jan 2010. Available from: URL: http://dx.doi.org/10.3899/jrheum.090647 803006802 Japan
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Reactions 6 Mar 2010 No. 1291
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