Tumor necrosis factor-alpha antagonist-induced sarcoidosis

J Clin Rheumatol. 2010 Sep;16(6):274-9. doi: 10.1097/RHU.0b013e3181efa190.


Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Tumor necrosis factor (TNF)-alpha is an important player in granuloma formation, and recent clinical trials have investigated the efficacy of TNF-alpha inhibitors in sarcoidosis. Paradoxically, there are several case reports in the medical literature describing the development of sarcoidosis in patients treated with TNF-alpha inhibitors. We describe 3 cases of TNF-alpha antagonist-induced sarcoidosis: 1 case of pulmonary, ocular and cutaneous sarcoidosis developing in a patient receiving infliximab for erosive rheumatoid arthritis, 1 case of etanercept-induced sarcoidosis in a patient with seronegative rheumatoid arthritis, and 1 case of sarcoidosis developing in a patient receiving etanercept for erosive rheumatoid arthritis. We also provide a brief discussion on the role of TNF alpha in granuloma formation and implications in the use of TNF-alpha antagonists in autoimmune disease.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use
  • Arthritis, Rheumatoid / drug therapy
  • Biopsy
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / adverse effects*
  • Immunoglobulin G / therapeutic use
  • Infliximab
  • Lung / pathology
  • Middle Aged
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Sarcoidosis / chemically induced*
  • Sarcoidosis / diagnosis
  • Sarcoidosis / pathology
  • Sarcoidosis, Pulmonary / chemically induced*
  • Sarcoidosis, Pulmonary / diagnosis
  • Sarcoidosis, Pulmonary / pathology
  • Skin / pathology
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*


  • Antibodies, Monoclonal
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Etanercept