Systemic sarcoidosis induced by etanercept: first Brazilian case\nreport
A fifty year-old female patient, Caucasian, born in Rio de Janeiro, was diagnosed with\nrheumatoid arthritis 10 years ago. She started treatment with weekly etanercept 50 mg\nsubcutaneously over one year ago, due to a poor therapeutic response to methotrexate,\nsulphasalazine and corticoids. Prior to starting the immunobiologic therapy, the patient\nwas screened with thoracic radiographies, PPD and HIV and hepatitis serologic tests, all\nwith normal results.\nAfter 6 months of treatment with etanercept, infiltrated erythematous lesions appeared\nsurrounding a scar on the posterior region of the right thigh and right gluteal area,\nfollowed by the emergence of painful erythematous nodules on lower limbs and an increase\nof volume on the neck ( and ). Our patient denied fever, weight loss and\ndyspnea. At this point, thoracic and cervical computerized tomography scans were\nperformed, showing pulmonary perihilar lymphadenomegaly and bilateral augmentation of\nparotids without lymphadenomegaly, respectively (). Histopathological examination of the right thigh skin lesion demonstrated\nthe presence of noncaseating granulomas formed by histiocytes and giant cells in the\ndermis and hypodermis ( and ).\nSkin cultures for mycobacteria and fungi were negative and angiotensin converting enzyme\nlevels were 61 U/L (reference value: < 60 U/L).\nEtanercept was suspended after the diagnosis of sarcoidosis, and treatment with\nprednisone 30mg/day p.o. was initiated resulting in an improvement of skin, cervical and\npulmonary lesions within approximately 30 days.\nThe dose of prednisone was gradually reduced after 3 months, and no relapse of symptoms\nwas observed after 6 months of follow-up.