Tumor necrosis factor-alpha (TNF-α)-blockade-induced hepatic sarcoidosis in psoriatic arthritis (PsA): case report and review of the literature

Clin Rheumatol. 2011 Jan;30(1):133-7. doi: 10.1007/s10067-010-1577-1. Epub 2010 Oct 1.

Abstract

To study the cytokine profile in a 52 year old woman with psoriasis, PsA, and HCV who developed hepatic sarcoidosis following Etanercept therapy for 7 months. 11 PsA patients on TNF blockers mean disease duration 158.4 (SD 114.5), mean treatment duration 72.1 (SD 42.14) months, 8/11 PsA were on Etanercept and 5 healthy controls were studied. TNF-α, sTNF RI/RII, IFN-α/β/γ, IL-1 α, IL-15, IL-6, VEGF, s IL-1 R, sIL-6 R, IL-12, IL-23, IL-17, Adiponectin, Leptin and EGF were assessed. All PsA and controls tested negative for Quantiferon TB Gold, hepatitis B/C, HIV, ACE level, chest x-ray, liver function test (LFTs). Serologic biomarkers of the subject in comparison to the controls indicate that sTNF RI value was significantly higher; and IL-1 alpha level has a high outlier compared to the 11 PsA patients on TNF blockers. The clinical course, histologic findings, increased levels of s TNF R I and IL-1 α in the subject as compared to the other PsA on TNF blockade and controls, suggest that most likely Etanercept induced inflammatory cytokine imbalance was responsible for inducing hepatic sarcoidosis.

Publication types

  • Case Reports

MeSH terms

  • Arthritis, Psoriatic / complications
  • Arthritis, Psoriatic / immunology*
  • Female
  • Granuloma / complications
  • Granuloma / immunology
  • Hepacivirus / genetics
  • Hepatitis C / complications
  • Hepatitis C / immunology
  • Humans
  • Liver / immunology*
  • Liver Diseases / complications
  • Liver Diseases / immunology*
  • Middle Aged
  • Psoriasis / complications
  • Psoriasis / immunology
  • Sarcoidosis / complications
  • Sarcoidosis / immunology*
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Viral Load

Substances

  • Tumor Necrosis Factor-alpha