Thoracale adenopathieën en neutropenie: een onverwachte diagnose

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.