Tumour necrosis factor (TNF) inhibitor-induced isolated pleural granulomas: a rare adverse effect. BMJ Case Rep 2017 Jun 18;2017
Date
06/21/2017Pubmed ID
28630242Pubmed Central ID
PMC5534705DOI
10.1136/bcr-2017-219883Scopus ID
2-s2.0-85020923415 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
A 53-year-old man with a history of Crohn's disease on infliximab, presented with several weeks of cough and dyspnoea. He had a right-sided pleural effusion, found to be exudative with lymphocytic predominance. He underwent right-sided video-assisted thoracic surgery (VATS) with biopsies and pleurodesis. Histopathology showed pleural-based non-caseating granulomas with unremarkable lung parenchyma. Cultures were only positive for Propionibacterium acnes 8 months later, he was found to have a left-sided exudative, lymphocytic predominant pleural effusion. Left-sided VATS and biopsies again showed pleural-based non-caseating granulomas with normal lung parenchyma. Having ruled out an active infection and malignant lesions, we diagnosed infliximab-induced pleural granulomas. Infliximab was stopped. The patient continues to do well at 6 years of follow-up. We believe this is the first report of tumour necrosis factor (TNF) inhibitor-induced isolated pleural granulomas. P. acnes and cytokine imbalance might be responsible for the pathogenesis of TNF inhibitor-induced granulomas.
Author List
Ali MS, Franco R, Dhotre D, Rao NAuthor
Rose Franco MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
CoughCrohn Disease
Dyspnea
Gastrointestinal Agents
Gram-Positive Bacterial Infections
Granuloma
Humans
Infliximab
Male
Middle Aged
Pleural Effusion
Pleurodesis
Propionibacterium acnes
Thoracic Surgery, Video-Assisted
Time Factors
Treatment Outcome
Tumor Necrosis Factor-alpha
