A. Depover, G. Serry, E. Degrande, P. Wilmes, E. Steenkiste, V. Van Damme
{"title":"Thoracale adenopathieën en neutropenie: een onverwachte diagnose","authors":"A. Depover, G. Serry, E. Degrande, P. Wilmes, E. Steenkiste, V. Van Damme","doi":"10.47671/tvg.80.24.025","DOIUrl":null,"url":null,"abstract":"Thoracic lymphadenopathies and neutropenia: an unexpected diagnosis\n\n \n\nA 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.\n\n \n\nAfter 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.","PeriodicalId":507632,"journal":{"name":"Tijdschrift voor Geneeskunde","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Tijdschrift voor Geneeskunde","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.47671/tvg.80.24.025","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
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.