Miedema Jelle, Nunes Hilario
Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Hôpital Avicenne, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares de l'adulte, Bobigny, France.
Curr Opin Pulm Med. 2021 Sep 1;27(5):439-447. doi: 10.1097/MCP.0000000000000800.
Sarcoidosis is a complex granulomatous disease of unknown cause. Several drug categories are able to induce a systemic granulomatous indistinguishable from sarcoidosis, known as drug-induced sarcoidosis-like reaction (DISR). This granulomatous inflammation can resolve if the medication is discontinued. In this review, we discuss recent literature on medication associated with DISR, possible pathophysiology, clinical features, and treatment.
Recently, increasing reports on DISR have expanded the list of drugs associated with the systemic granulomatous eruption. Most reported drugs can be categorized as combination antiretroviral therapy, tumor necrosis factor-α antagonist, interferons, and immune checkpoint inhibitors, but reports on other drugs are also published. The proposed mechanism is enhancement of the aberrant immune response which results in systemic granuloma formation. It is currently not possible to know whether DISR represents a separate entity or is a triggered but 'true' sarcoidosis.As DISRs may cause minimal symptoms, treatment is not always necessary and the benefits of continuing the offending drug should be weighed against clinical symptoms and organ dysfunction. Treatment may involve immunosuppressive medication that is used for sarcoidosis treatment.
In this article, we review recent insights in DISR: associated drug categories, clinical presentation, diagnosis, and treatment. Additionally, we discuss possible mechanisms of DISR which can add to our knowledge of sarcoidosis pathophysiology.
结节病是一种病因不明的复杂肉芽肿性疾病。有几类药物能够诱发一种与结节病难以区分的全身性肉芽肿，即药物性结节病样反应（DISR）。如果停用该药物，这种肉芽肿性炎症可能会消退。在本综述中，我们讨论了近期关于与DISR相关的药物、可能的病理生理学、临床特征及治疗的文献。
最近，关于DISR的报道不断增加，扩大了与全身性肉芽肿性皮疹相关的药物清单。大多数报道的药物可归类为抗逆转录病毒联合疗法、肿瘤坏死因子-α拮抗剂、干扰素和免疫检查点抑制剂，但也有关于其他药物的报道。提出的机制是异常免疫反应增强，导致全身性肉芽肿形成。目前尚无法确定DISR是一个单独的实体还是一种触发的但“真正的”结节病。由于DISR可能仅引起轻微症状，并非总是需要治疗，应权衡继续使用致病药物的益处与临床症状和器官功能障碍。治疗可能涉及用于结节病治疗的免疫抑制药物。
在本文中，我们综述了DISR的最新见解：相关药物类别、临床表现、诊断和治疗。此外，我们讨论了DISR的可能机制，这有助于我们了解结节病的病理生理学。
