Tumor Necrosis Factor-Alpha Inhibitor-Induced Sarcoid-Like Reaction in a Patient With Juvenile Idiopathic Arthritis: A Case Report

TL;DR

A young man with arthritis developed a sarcoid-like lung reaction while on a TNF-α inhibitor and improved after switching medications.

Contribution

Reports a rare sarcoid-like reaction in a JIA patient treated with adalimumab and its successful management.

Findings

Adalimumab therapy was associated with pulmonary sarcoid-like granulomas in a JIA patient.

Discontinuation of adalimumab and treatment with methotrexate and prednisone led to clinical and radiological improvement.

The case underscores the need to consider paradoxical reactions in patients on TNF-α inhibitors with respiratory symptoms.

Abstract

Tumor necrosis factor-alpha (TNF-α) inhibitors are effective biologic disease-modifying antirheumatic drugs (bDMARDs) commonly used to treat various inflammatory conditions. While generally considered safe, these agents have been associated with paradoxical immune-mediated adverse effects, including sarcoid-like reactions. We present the case of a 24-year-old male with juvenile idiopathic arthritis (JIA) who developed pulmonary manifestations of a sarcoid-like reaction while on adalimumab therapy. The patient presented with progressive dyspnea, and imaging revealed diffuse bilateral ground-glass opacities with hilar lymphadenopathy. Endobronchial ultrasound-guided biopsy confirmed non-necrotizing granulomas with giant cells and eosinophils, consistent with a sarcoid-like reaction. Following discontinuation of adalimumab and initiation of methotrexate and prednisone therapy, the patient showed significant clinical and radiological improvement. This case highlights the importance of considering paradoxical drug reactions in patients on TNF-α inhibitors who present with respiratory symptoms and emphasizes the need for prompt diagnosis and appropriate management.

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