Department of Rheumatology, Nishinomiya Municipal Central Hospital, Japan.
Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Japan.
Intern Med. 2023 Nov 1;62(21):3251-3254. doi: 10.2169/internalmedicine.1326-22. Epub 2023 Mar 15.
An 80-year-old woman with rheumatoid arthritis during treatment with etanercept, a tumor necrosis factor (TNF) inhibitor, showed swelling of the salivary glands and retroperitoneal fibrosis, which was diagnosed as IgG4-related disease. Although some reports have shown the efficacy of TNF inhibitors for IgG4-related disease or retroperitoneal fibrosis, TNF inhibitors sometimes cause paradoxical reactions like psoriasis, and the mechanisms are considered to involve the upregulation of plasmacytoid dendritic cells and IFN-α, which is also common in patients with IgG4-related disease. This is a case report of IgG4-related retroperitoneal fibrosis with the possibility of a rare paradoxical reaction by a TNF inhibitor.
一位 80 岁患有类风湿关节炎的女性在接受肿瘤坏死因子（TNF）抑制剂依那西普治疗时，出现唾液腺肿胀和腹膜后纤维化，被诊断为 IgG4 相关疾病。虽然一些报告显示 TNF 抑制剂对 IgG4 相关疾病或腹膜后纤维化有效，但 TNF 抑制剂有时会引起类似银屑病的矛盾反应，其机制被认为涉及浆细胞样树突状细胞和 IFN-α的上调，这在 IgG4 相关疾病患者中也很常见。这是一例 IgG4 相关腹膜后纤维化的病例报告，可能是 TNF 抑制剂引起的罕见矛盾反应。
