Etanercept-associated Pulmonary Granulomatous Inflammation in Patients with Rheumatoid Arthritis

To the Editor: We describe 4 patients with rheumatoid arthritis (RA) who developed noninfectious pulmonary granulomatous disease while treated with etanercept (Table 1).All patients improved with withdrawal of etanercept and addition of prednisone, without use of antibiotic, antifungal, or antimycobacterial medications. They were subsequently treated with adalimumab with no recurrence of pulmonary toxicity. Patient 1. After an inadequate response to leflunomide, a 60-year-old man with 1 year of seropositive RA started etanercept, with subsequent improvement. He then experienced progressive malaise and a 40-lb weight loss. Chest radiograph and computed tomography (CT) scan revealed multiple pulmonary nodules bilaterally. Open-lung biopsy demonstrated ...