Tonsillar lymphoid alterations caused by TNF-α inhibitors: an iatrogenic mimicker of lymphoproliferative disorders.

A 39 year old woman presented with complaints of throat swelling and a history of multiple courses of antibiotic treatment for clinically diagnosed sinusitis and tonsillitis occurring over a period of greater than one year. Despite treatment, she still noted difficulty in eating once or twice a month due to pharyngeal discomfort. She had been diagnosed with Crohn disease 18 months previously and had begun treatment with infliximab (Remicade, Janssen Biotech, Inc.) at that time. She also noted that she had suffered a long history of chronic sinusitis as a child, but felt she had "grown out of it" until it had apparently been reactivated at the time infliximab therapy was started. A CT scan of the neck and larynx demonstrated tonsillar enlargement, as well as mild acute sinusitis in the left maxillary region. Bilateral tonsillectomy was performed.