Sarcoid Intermediate Uveitis Following Etanercept Treatment: A Case Report and Review of the Literature

Figures & data

FIGURE 1  A: Biomicroscopy of left eye showing anterior granulomatous uveitis. B: Funduscopy of left eye showing snow-balls in the inferior vitreous cavity.

FIGURE 2  Non-caseating granuloma mainly composed of epithelioid cells with scattered lymphocytes in ultrasound-guided transbronchial biopsy of mediastinal adenopathy (Cell block; Hematoxylin and eosin stain; X400).

TABLE 1  Results of ancillary testing not contributory to etiological diagnosis.

Cerebrospinal fluid analysis
Leukocytes/mm^3	5
Glucose (mg/dL)	40
Protein (mg/dL)	88
Oligoclonal bands	Negative
Adenosine deaminase (IU/L)	8
Auramine and Gram staining	Negative
Cytology	Negative
Culture	Negative
Serological analysis
Syphilis (Rapid Plasma Reagin test)	Negative
Borrelia burgdorferi	Negative
Epstein-Barr virus	IgG positive, IgM negative
Human immunodeficiency virus (p24 Antigen)	Negative
Human T-lymphotropic virus	Negative
Nuclear magnetic resonance imaging
Brain	Normal
Spine	Normal

TABLE 2  Clinical features of patients who developed uveitis and sarcoid-like granulomatosis while on anti-TNFα therapy: review of the literature.

Author	Age/sex/disease	Anti- TNFα/ months of therapy at the onset of symptoms	Type of uveitis	Nonocular signs and symptoms	Histological diagnosis (tissue)	Treatment/outcome
Hashkes et al. (2003)	41/M/JIA	Etanercept/2	PanU	Skin rash, hepatitis	Yes (liver)	Etanercept withdrawn. Steroids/uveitis resolved.
Sturfelt et al. (2007)	41/F/RA	Infliximab/69	Granulomatous AU, retinal periphlebitis	Mediastinal adenopathies, meningoencephalitis, parotiditis	Not performed	Infliximab withdrawn. Steroids, methotrexate/uveitis resolved.
Louie et al. (2008)	35/F/AS	Etanercept/1	AU	Pulmonary nodules and infiltrates, paratracheal, subcarinal, mediastinal, and bilateral hilar adenopathies	Yes (lung)	Etanercept withdrawn. Steroids/uveitis resolved.
Daïen et al. (2009)	69/F/RA	Etanercept/27	AU	Erythema nodosum, mediastinal adenopathies, lung infiltrates	Yes (lung and mediastinal lymph nodes)	Etanercept continuation. Steroids. Switching to adalimumab 33 months later/Uveitis resolved.
Suzuki et al. (2009)	51/F/RA	Etanercept/not reported	AU, chorioretinal exudates, papillitis, retinal periphlebitis	Hilar adenopathies, subcutaneous nodules	Yes (skin)	Etanercept withdrawn. Steroids/uveitis resolved.
Skoie et al. (2009)	42/M/AS	Etanercept/12	PU	Parotiditis, submandibular sialadenitis, adenopathies in the anterior cervical chain, and in the para-aortic and mesenteric regions, hepatitis	Yes (salivary gland from the lower lip and liver)	Etanercept withdrawn. Steroids and azathioprine. /uveitis resolved.
Present case (2011)	30/F/PsA	Etanercept/48	AU and IU	Hilar and mediastinal adenopathies	Yes (mediastinal adenopathies)	Etanercept withdrawn. Steroids and methotrexate. Ustekinumab for skin disease/uveitis resolved.

Note. M, male; JIA, juvenile idiopathic arthritis; F, female; RA, rheumatoid arthritis; AS, ankylosing spondylitis; PsA, psoriatic arthritis; PanU, panuveitis; AU, anterior uveitis; PU, posterior uveitis; IU, intermediate uveitis.