Adalimumab
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Reactions 1455 - 8 Jun 2013 S Adalimumab Sarcoidosis-like granulomatosis in an elderly patient: case report A 66-year-old man developed sarcoidosis-like granulomatosis during adalimumab treatment for psoriatic arthritis. The man presented with hoarseness and dysphagia of 2 months’ duration. He also complained of a small ulcer on the left aspect of his tongue. He had a history of psoriatic arthritis that was controlled with adalimumab, which had been commenced about 6 years previously [route and dosage not stated]; he had been receiving adalimumab continuously for the past 2 years. Flexible endoscopy revealed oedema of the postcricoid region and the aryepiglottic folds, and a lesion in the left pyriform sinus. The left vocal cord displayed reduced mobility. The man was admitted for further investigation. A CT scan of the head and neck demonstrated a large soft tissue erosion on the left aspect of the oropharynx, the hypopharynx and the supraglottic region, pushing forward the left arytenoid. The jugular lymph nodes on the left side of the neck were marginally enlarged. A biopsy under general anaesthetic showed a big, oedematous enlargement of the left hemilarynx. The ulcer on his tongue was removed and sent for examination. Staining of the biopsied material from both sites revealed numerous epithelioid, non-necrotic granulomas with giant cells at the lamina propria. Granulomatous reaction was also observed between the striated muscle fibres. These findings were consistent with a chronic granulomatous inflammation, 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 chronic granulomatous reaction consistent with sarcoidosis developed after 2 years of continuous treatment with adalimumab". Christoforidou A, et al. Sarcoidosis-like granulomatosis of the hypopharynx as a complication 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. 1455 0114-9954/10/1455-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Adalimumab
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
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Reactions 8 Jun 2013 No. 14550114-9954/10/1455-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
