AI Article Synopsis
- * Doctors suspected either a bacterial infection or a condition related to adalimumab like sarcoidosis; however, no improvement was seen after stopping the medication, which led to further testing.
- * A biopsy indicated sarcoidosis-related granulomas causing lung issues, and treatment with prednisolone reduced the lung shadows, while switching to another medication for AS did not worsen the condition.
Article Abstract
A 28-year-old man with ankylosing spondylitis (AS) who was treated with a tumour necrosis factor-alpha (TNF-α) inhibitor, adalimumab, presented with newly detected multiple bilateral pulmonary nodules on chest computed tomography (CT). We suspected bacterial infection, including those caused by acid-fast bacilli, or adalimumab-related condition, such as sarcoidosis. After adalimumab cessation, no resolution of the pulmonary shadows was observed. Moreover, pulmonary cavitation appeared on chest CT at 7 weeks, prompting surgical lung biopsy. Acid-fast bacteria culture of the lung tissue showed negative results. Pathological examination suggested that confluent granulomas associated with sarcoidosis might have obstructed the blood vessels, causing necrosis and lung cavitation. Consequently, prednisolone was initiated, and these shadows were reduced. After administering anti-interleukin (IL)-17A antibody for treatment of AS and prednisolone withdrawal, these shadows were not exacerbated. TNF-α inhibitor-induced sarcoidosis could cause cavitary lesions due to vascular invasion of granulomas.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9673597 | PMC |
| http://dx.doi.org/10.1002/rcr2.1065 | DOI Listing |
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