A patient who is being treated with a tumor necrosis factor (TNF) alpha blocking agent may develop sarcoidosis. This is intriguing since some patients with refractory sarcoidosis respond favorably to these agents.
Clinical findings:
(1) The patient is being treated with a TNF alpha blocking agent, especially etanercept.
(2) The patient had no evidence of sarcoidosis prior to starting TNF alpha blocking agent therapy.
(3) The patient develops non-caseating granulomas in lungs, lymph nodes, skin, salivary glands and/or other sites, with or without systemic symptoms.
(4) Culture of the granulomas are negative and there is no evidence of an occult myocobacterial or fungal infection.
(5) Discontinuation of the TNF alpha blocking agent therapy is associated with regression of the granulomas.
Rechallenge with the same drug may not result in relapse of the sarcoidosis. However, if continued therapy with a TNF alpha blocking agent is needed then an alternative blocking agent is usually selected.
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