Nnodum Benedicta Nneoma, Hariri Lida P, Mavrommati Despoina, Dudley Lauren
Department of Internal Medicine, Berkshire Medical Center, Pittsfield, Massachusetts, USA.
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Case Rep Rheumatol. 2019 Jun 16;2019:7121539. doi: 10.1155/2019/7121539. eCollection 2019.
Antitumor necrosis factor- therapy has been used effectively in treatment of many inflammatory diseases such as rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease. There are increasing number of paradoxical reactions associated with this therapy that are being reported. We present the case of a 63-year-old male with psoriatic arthritis maintained on adalimumab and methotrexate (previous treatment trials of prednisone and leflunomide) who developed severe symptomatic sarcoidosis in the brain, liver, and lung. Upon discontinuation of adalimumab, the symptoms resolved but the imaging findings persisted. Although the development of sarcoidosis (usually in the lung, skin, and eyes) while on antitumor necrosis factor- therapy is increasingly reported, the brain and liver are less commonly involved but should be borne in mind by physicians when extensive granulomatous lesions develop.
抗肿瘤坏死因子疗法已被有效地用于治疗许多炎症性疾病，如类风湿性关节炎、银屑病、银屑病关节炎、强直性脊柱炎和炎症性肠病。与这种疗法相关的矛盾反应报告越来越多。我们报告一例63岁男性银屑病关节炎患者，他一直在接受阿达木单抗和甲氨蝶呤治疗（之前曾试用泼尼松和来氟米特），却在脑、肝和肺中出现了严重的有症状结节病。停用阿达木单抗后，症状缓解，但影像学表现仍持续存在。虽然越来越多的报告称在接受抗肿瘤坏死因子疗法时会出现结节病（通常累及肺、皮肤和眼睛），但脑和肝较少受累，不过当出现广泛的肉芽肿性病变时，医生应予以关注。
