Sarcoidosis in a patient with psoriasic arthritis after use of ANTI-TNF

Abstract

Objective: To report a case of psoriatic arthritis that evolved into sarcoidosis after seven years of use of tumor necrosis factor antagonist (anti-TNF) drugs, adalimumab and, later, etanercept. Case details: Female patient, 64 years old, diagnosed with psoriatic arthritis, used adalimumab for two years and, after therapeutic failure, was switched to etanercept, which had been used for five years. He had recurrent polyarthralgia and persistent fatigue. On physical examination, left ankle arthritis, nail dystrophy and pitting. No palpable lymph node enlargement and active psoriasis lesions. Abdominal tomography showed retroperitoneal lymph node enlargement, and it was decided to perform a biopsy via laparotomy. The histopathological findings were non-caseating epithelioid granulomas and immunohistochemistry showed findings consistent with chronic granulomatous lymphadenitis, suggesting sarcoidosis. Considerations: Anti-TNFs are used to treat sarcoidosis, however it is believed that these drugs do not inhibit all signaling pathways, thus resulting in "escape" routes and, in some cases, causing sarcoidosis secondary to these drugs. If the patient does not present respiratory symptoms and granulomatous skin lesions, we must be aware of the possibility of antiTNF-induced sarcoidosis.