Atilla TÜRKYILMAZ, Erhan ÇAPKIN, Elvan ŞENTÜRK, Savaş ÖZSU

Anti-tnf tedavi ile ilişkili lupus like sendromu

Elli altı yaşında erkek hasta; gece terlemesi, nefes darlığı, öksürük, sarı renkli balgam ve ateş şikayetiyle başvurdu. Özgeçmişinde,ankilozanspondilit nedeniyle tümör nekroz faktörü-alfa (TNF-α) antagonisti (etanersept) kullanım öyküsü vardı. Postero-anteriorakciğer grafisinde; sağ sinüs künt, sağ diyafragma üstünde diyafragmadan perifere uzanan atelektazi ile uyumlu lineer opasite, solplevral efüzyon, sol orta bazal parakardiyak opasite mevcuttu. Toraks tomografisinde; perikardiyal ve plevral efüzyon ve komşu akciğer parankiminde kompresif atelektazi saptandı. Sitolojik incelemede lenfosit hakimiyeti saptandı. Plevra biyopsisinde aktif kronikplöritis ve fibrinöz eksüda, bening sitoloji olarak raporlandı. Olguda anti-TNF bağlı lupus nedeniyle gelişen plörezi düşünüldü. Üç gün100 mg prednol uygulandı. Bir ay sonraki kontrolde, sıvıda belirgin gerileme saptandı.

Lupus-like syndrome in patients treated with anti-tnf-α factors

A 56-year-old male patient presented with history of complaints of night sweats, short ness of breath, cough and yellow sputum, fever. There was a history of tumor neurosis factor-alpha (etanercept) due to ankylosing spondylitis. Postero-anterior chest X-ray; the right sinus was blunt, the right diaphragm had linear opacity compatible with atelectasis extending from the diaphragm to the periphery, left pleural effusion, left middle basal paracardiac opacity. In thorax tomography; pleural effusion and pericardial effusion and compressive atelectasis in the adjacent lung parenchyma were detected. Lymphocyte dominance had in cytological examination. Active chronic pleuritis and fibrinous exudate as benign cytology were reported in pleural biopsy. We are thought to develop pleurisy due to anti TNF-induced lupus like syndrome. 100 mg prednol was applied for three days. One month later the control was found toregress in the filter.

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Olsen NJ. Drug-induced autoimmunity. Best Practice Research Clinical Rheumatology 2004;18:677-4.
Yung RL, Richardson BC. Drug-induced lupus. Rheum Dis Clin North Am 1994;20:61-86.
Yung RL, Johnson KJ, Richardson BC. New concepts in the pathogenesis of drug-induced lupus. Lab Invest 1995;73:746-59.
De Rycke L, Kruithof E, Van Damme N, Hoffman IE. Anti nuclear anti bodies following infliximab treatment in patients with rheumatoid arthritis or spondyl arthropathy. Arthritis Rheum 2003;48:1015-23.
Botsios C. Safety of tumour necrosis factor and interleukin-1 blocking agents in rheumatic diseases. Autoimmunity Reviews 2005;4:162-70.
Crum NF, Lederman ER, Wallace MR. Infections associated with tumor necrosis factor-α antagonists. Medicine 2005;84:291-302.
Gomez-Reino JJ, Carmona L, Valverde VR, Mola EM, Montero MD; BIOBADASER Group. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthritis Rheum 2003;48:2122-7.
Dixon WG, Hyrich KL, Watson KD, Lunt M, Galloway J, Ustianowski A, et al. Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the British Society for Rheumatology Biologics Register (BSRBR). Ann Rheum Dis 2010;69:522- 8.
Kanellopoulou T, Filiotou A, Kranidioti H, Dourakis SP. Sarcoid-like granulomatosis in patients treated with antiTNF-α factors. A case report and review of the literature. Clin Rheumatol 2011;30:581-3.
King TE, Cherniak RM, Schwarz MI. The lungs and connective tissue diseases. In: Murray JF, Nadel JA (eds). Textbook of Pulmonary Medicine. 2nd ed. Philadelphia: WB Saunders Company, 1994:1865-6.
Rosenow E, Strimlan CV, Muhm JR, Ferguson RH. Pleuropulmonary manifestations of ankylosing spondylitis. Mayo Clin Proc 1977;52:641-9.
Benucci M, Gobbi FL, Fossi F, Manfredi M, Del Rosso A. Drug-induced lupus after treatment with infliximab in rheumatoid arthritis. J Clin Rheumatol 2005;11(1):47-9.
Aringer M, Smolen JS. The role of tumor necrosis factoralpha in systemic lupus erythematosus. Arthritis Res Ther 2008;10(1):202.
De Bandt M, Sibilia J, Le Loet X, Prouzeau S, Fautrel B, Marcelli C, et al. Club rhumatismes et inflammation. Systemic lupus erythematosus induced by anti-tumour necrosis factor alpha therapy: a French national survey. Arthritis Res Ther 2005;7(3):R545-R551.
Mongey AB, Hess EV. Drug insight: auto immune effects of medications: what’s new? Nat Clin Pract Rheumatol 2008;4(3):136-44.
Furin JJ, Johnson JL. Recent advances in the diagnosis and management of tuberculosis. Curr Opin Pulm Med 2005;11:189-94.