Sarcoidosis appearing during anti-Tumor Necrosis Factor alfa therapy: a new "class effect" paradoxical phenomenon. Two case reports and literature review.

Objectives: to report 2 cases of sarcoidosis developed during treatment with anti-TNFalfa antagonists, infliximab and adalimumab, used for inflammatory rheumatic diseases and to review previously. Methods: we describe 2 patients, the first withy psoriatic arthritis, the second with rheumatoid arthritis, who developed noncaseating granulomas of the lung consistent with sarcoidosis while being treated with anti-TNFalfa drugs. a retrospective review of the literature was performed using the PubMed database. Results: in our patients sarcoidosis developed after 2 years of continuous treatment with infliximab and adalimumab. Both patients presented with low grade fever, chest pain, and dyspnea. The diagnosis of sarcoidosis was established by the typical well-formed noncaseating granuloma on transbronchial biopsy. Following withdrawal of anti-TNFalfa agents and a brief course of steroids, the clinical picture resolved. Thirteen additional cases of sarcoidosis that developed after anti-TNF alfa treatment have been reported, and in 9 of these the causative agent was etanercept. Conclusions: the developement of sarcoidosis during treatment with TNFalfa antagonists represents a rare and paradoxical adverse event. The occurrence of sarcoidosis with all 3 available agents suggests a new "class effect" probably linked to a cytokine disequilibrium in patients receiving anti-TNFalfa treatment.