Sadettin USLU, Semih GÜLLE, Naciye Sinem GEZER, Sermin ÖZKAL, Fatoş ÖNEN

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

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

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.

Keywords:

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

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