Author:
Depover A.,Serry G.,Degrande E.,Wilmes P.,Steenkiste E.,Van Damme V.
Abstract
Thoracic lymphadenopathies and neutropenia: an unexpected diagnosis
A 68-year-old patient, known with rheumatoid arthritis (RA) and treated with TNF-alpha antagonists, presents with a persistent cough with coloured sputum. Further examination reveals neutropenia and thoracic adenopathies. Histopathologic examination shows non-necrotizing granulomas in the thoracic lymph nodes and bone marrow.
After infectious and malignant evaluation, the diagnoses of sarcoidosis and sarcoidosis-like granulomatosis by TNF-alpha antagonists are made. The clinic, imaging, laboratory findings and histopathology do not allow the doctors to distinguish between the 2 diagnoses. Several arguments point in the direction of sarcoidosis-like granulomatosis due to TNF-alpha antagonists. First, there is a temporal relationship between the initiation of the antagonists and the finding of granulomas. Additionally, the association of RA and sarcoidosis is extremely rare. Sarcoidosis-like granulomatosis due to TNF-alpha antagonists may be considered as a form of drug-induced sarcoidosis.
Reference19 articles.
1. 1. Drent M, Crouser ED, Grunewald J. Challenges of sarcoidosis and its management. N Engl J Med 2021; 385: 1018-1032.
2. 2. Ungprasert P, Ryu JH, Matteson EL. Clinical manifestations, diagnosis, and treatment of sarcoidosis. Mayo Clin Proc Innov Qual Outcomes 2019; 3: 358-375.
3. 3. Asano S. Granulomatous lymphadenitis. J Clin Exp Hematop 2012; 52: 1-16.
4. 4. Ohshimo S, Guzman J, Costabel U, Bonella F. Differential diagnosis of granulomatous lung disease: clues and pitfalls. Number 4 in the series ‘Pathology for the clinician’, edited by Peter Dorfmüller and Alberto Cavazza. Eur Respir Rev 2017; 26: 170012.
5. 5. Bhargava V, Farhi DC. Bone marrow granulomas: clinicopathologic findings in 72 cases and review of the literature. Hematol Pathol 1988; 2: 43-50.