Sarcoidosis During Anti-Tumor Necrosis Factor-α Therapy: No Relapse After Rechallenge

To the Editor: Anti-tumor necrosis factor (TNF)-α agents such as infliximab, adalimumab, and etanercept are more and more widely used. With this we see a growing number of case reports describing adverse events that occur during anti-TNF-α therapy. One adverse event that has been reported increasingly is the development of sarcoidosis1. This raises many questions. TNF-α plays an important role in the formation of granulomas. Based on this, specific anti-TNF-α agents are supposed to be effective in the treatment of granulomatous diseases such as Crohn’s disease and sarcoidosis. Although current evidence supports the efficacy of infliximab in Crohn’s disease, data regarding anti-TNF-α in sarcoidosis have been conflicting2,3. We describe 2 cases in which sarcoidosis occurred during respectively adalimumab and etanercept treatment, both for rheumatoid arthritis. After cure/stabilization of the sarcoidosis both patients were rechallenged with the anti-TNF-α agent they took originally. The first patient was a 55-year-old woman with rheumatoid arthritis (RA) for 5 years. Eight months after treatment with adalimumab 40 mg every 2 weeks, she developed erythema nodosum-like lesions … Address correspondence to D. van der Stoep. E-mail: dfvanderstoep{at}gmail.com