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Tumor Necrosis Factor-Alpha Inhibitor-Induced Sarcoid-Like Reaction in a Patient With Juvenile Idiopathic Arthritis: A Case Report

Year: 2025

Type: article

Abstract: Tumor necrosis factor-alpha (TNF-α) inhibitors are effective biologic disease-modifying antirheumatic drugs (bDMARDs) commonly used to treat various inflammatory conditions. While generally considered safe, these agents have been associated with paradoxical immune-mediated adverse effects, including sarcoid-like reactions. We present the case of a 24-year-old male with juvenile idiopathic arthritis (JIA) who developed pulmonary manifestations of a sarcoid-like reaction while on adalimumab therapy. The patient presented with progressive dyspnea, and imaging revealed diffuse bilateral ground-glass opacities with hilar lymphadenopathy. Endobronchial ultrasound-guided biopsy confirmed non-necrotizing granulomas with giant cells and eosinophils, consistent with a sarcoid-like reaction. Following discontinuation of adalimumab and initiation of methotrexate and prednisone therapy, the patient showed significant clinical and radiological improvement. This case highlights the importance of considering paradoxical drug reactions in patients on TNF-α inhibitors who present with respiratory symptoms and emphasizes the need for prompt diagnosis and appropriate management.

Source: Cureus

DOI: 10.7759/cureus.84970

Authors: Thanda Aung, Marisa Prasanpanich, Avery Kaplan, Kaitlin Eblen, Gregory A Fishbein

Institutions: University of California, Los Angeles, Thai Red Cross Society, King Chulalongkorn Memorial Hospital

Language: English

Topic: Sarcoidosis and Beryllium Toxicity Research

Subfield: Physiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4410819983