Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
Chest. 2018 Sep;154(3):664-677. doi: 10.1016/j.chest.2018.03.056. Epub 2018 Apr 24.
A drug-induced sarcoidosis-like reaction (DISR) is a systemic granulomatous reaction that is indistinguishable from sarcoidosis and occurs in a temporal relationship with initiation of an offending drug. DISRs typically improve or resolve after withdrawal of the offending drug. Four common categories of drugs that have been associated with the development of a DISR are immune checkpoint inhibitors, highly active antiretroviral therapy, interferons, and tumor necrosis factor-α antagonists. Similar to sarcoidosis, DISRs do not necessarily require treatment because they may cause no significant symptoms, quality of life impairment, or organ dysfunction. When treatment of a DISR is required, standard antisarcoidosis regimens seem to be effective. Because a DISR tends to improve or resolve when the offending drug is discontinued, this is another effective treatment for a DISR. However, the offending drug need not be discontinued if it is useful, and antigranulomatous therapy can be added. In some situations, the development of a DISR may suggest a beneficial effect of the inducing drug. Understanding the mechanisms leading to DISRs may yield important insights into the immunopathogenesis of sarcoidosis.
药物诱导的类肉瘤样反应（DISR）是一种全身性肉芽肿反应，与类肉瘤无法区分，并且与起始药物的使用存在时间关系。在停用致病药物后，DISR 通常会改善或消退。有四种常见的药物类别与 DISR 的发展有关，分别是免疫检查点抑制剂、高效抗逆转录病毒疗法、干扰素和肿瘤坏死因子-α拮抗剂。与类肉瘤一样，DISR 不一定需要治疗，因为它们可能不会引起明显的症状、生活质量受损或器官功能障碍。当需要治疗 DISR 时，标准的抗类肉瘤症方案似乎是有效的。由于在停用致病药物时 DISR 往往会改善或消退，因此这也是治疗 DISR 的另一种有效方法。但是，如果药物有用，并不一定需要停用，并且可以添加抗肉芽肿治疗。在某些情况下，DISR 的发展可能表明诱导药物具有有益的作用。了解导致 DISR 的机制可能会深入了解类肉瘤症的免疫发病机制。
