Gonçalves Pimenta Diana Alexandra, Meira Leonor, Rolo Rui, Ferreira Lurdes
Pneumology Unit, Hospital of Braga.
Pneumology Unit, Portuguese Institute of Oncology (IPO), Porto.
Monaldi Arch Chest Dis. 2022 Jul 4;93(1). doi: 10.4081/monaldi.2022.2343.
Anti-TNF agents, namely adalimumab, are safe drugs that represent an important arsenal in the treatment of immune-mediated inflammatory diseases. "Paradoxical effects" have been described with their use. A sarcoidosis "like" reaction induced by these agents is rare and is characterized by a systemic granulomatous reaction indistinguishable from sarcoidosis. We present a 55-year-old male patient, with axial spondyloarthritis, treated with with adalimumab. About 17 months under this therapy, he complained of dry cough and wheezing. Chest CT showed a peri-lymphatic and pericisural micronodular pattern and hilo-mediastinal lymph nodes, suggestive of sarcoidosis. Angiotensin converting enzyme was increased. Assuming the hypothesis of a sarcoidosis-like reaction secondary to adalimumab this therapy was discontinued with progressive improvement in the patient's complaints and in the radiological changes.
抗 TNF 药物，即阿达木单抗，是治疗免疫介导的炎症性疾病的重要药物，且安全性良好。使用这类药物时曾有“矛盾效应”的报道。由这些药物诱发的类结节病反应较为罕见，其特征为全身性肉芽肿反应，与结节病难以区分。我们报告一例 55 岁男性轴向型脊柱关节炎患者，接受阿达木单抗治疗。在该治疗约 17 个月后，他出现干咳和喘息症状。胸部 CT 显示沿淋巴管周围和胸膜下的微小结节影以及肺门纵隔淋巴结肿大，提示结节病。血管紧张素转换酶升高。假设为阿达木单抗继发的类结节病反应，停用该治疗后患者症状逐渐改善，影像学改变也有所好转。
