Etanercept
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Pulmonary rheumatoid nodules: case report A 50-year-old man developed extensive pulmonary rheumatoid nodules while receiving etanercept for rheumatoid arthritis (RA). The man, who had a 10-year history of seropositive erosive RA, presented with pain in his left shoulder and a 12-month history of subcutaneous nodules on both arms. He had been receiving etanercept 25mg twice weekly and leflunomide for the last 2 and 3 years, respectively, and had previously been treated with methotrexate, sulfasalazine and infliximab. Physical examination showed arthritis of his left shoulder. Xrays of the shoulder revealed minor bony erosions and multiple densities in the apical portion of his left lung. Chest xray and CT scans showed disseminated, partly confluating nodules in both lungs with some pleural thickening and pleural effusion. Pulmonary function testing revealed a decreased total lung capacity of 4.2L. Histological examination of pleural and lung biopsies of multiple nodules revealed features typical of rheumatoid nodules. Etanercept and leflunomide were discontinued and the man was treated with prednisone and azathioprine. After 3 months, his pulmonary and subcutaneous nodules had mostly resolved. His lung function remained stable and he had no recurrence of nodules during follow-up. Author comment: "In our patient, nodulosis is probably related to concomitant etanercept treatment." van Ede AE, et al. Etanercept-related extensive pulmonary nodulosis in a patient with rheumatoid arthritis. The Journal of Rheumatology 34: 1590-1592, No. 7, Jul 801071969 2007 - Netherlands
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Reactions 28 Jul 2007 No. 1162
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