Reactions 1455 - 8 Jun 2013

SAdalimumab

Sarcoidosis-like granulomatosis in an elderlypatient: case report

A 66-year-old man developed sarcoidosis-likegranulomatosis during adalimumab treatment for psoriaticarthritis.

The man presented with hoarseness and dysphagia of2 months’ duration. He also complained of a small ulcer on theleft aspect of his tongue. He had a history of psoriatic arthritisthat was controlled with adalimumab, which had beencommenced about 6 years previously [route and dosage notstated]; he had been receiving adalimumab continuously forthe past 2 years. Flexible endoscopy revealed oedema of thepostcricoid region and the aryepiglottic folds, and a lesion inthe left pyriform sinus. The left vocal cord displayed reducedmobility.

The man was admitted for further investigation. A CT scan ofthe head and neck demonstrated a large soft tissue erosion onthe left aspect of the oropharynx, the hypopharynx and thesupraglottic region, pushing forward the left arytenoid. Thejugular lymph nodes on the left side of the neck weremarginally enlarged. A biopsy under general anaestheticshowed a big, oedematous enlargement of the left hemilarynx.The ulcer on his tongue was removed and sent forexamination. Staining of the biopsied material from both sitesrevealed numerous epithelioid, non-necrotic granulomas withgiant cells at the lamina propria. Granulomatous reaction wasalso observed between the striated muscle fibres. Thesefindings were consistent with a chronic granulomatousinflammation, such as sarcoidosis. Adalimumab was stopped.He was started on methotrexate, steroids and antituberculars,and his symptoms soon resolved.

Author comment: "In our patient, a chronicgranulomatous reaction consistent with sarcoidosis developedafter 2 years of continuous treatment with adalimumab".Christoforidou A, et al. Sarcoidosis-like granulomatosis of the hypopharynx as acomplication of anti-TNF therapy. American Journal of Otolaryngology 34:268-272, No. 3, May-Jun 2013. Available from: URL: http://dx.doi.org/10.1016/j.amjoto.2012.12.016 - Greece 803087745

1

Reactions 8 Jun 2013 No. 14550114-9954/10/1455-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved