[Association sarcoidosis and Horton disease: report of a case]

Lung and liver sarcoidosis-like reaction induced by tocilizumab

A drug-induced sarcoidosis-like reaction is a systemic granulomatous reaction indistinguishable from sarcoidosis and occurring in temporal relationship with a drug initiation. In this article, we report a patient who developed lung and liver granulomatous lesions following tocilizumab initiation for a giant cell arteritis. Infectious, toxic, neoplastic and inflammatory differential diagnoses were ruled out and lesions regressed after treatment cessation, leading to the diagnosis of tocilizumab induced sarcoidosis-like reaction. We review the 6 cases reported so far and emphasize the value of a prompt diagnosis. Finally, we discuss the potential pathophysiological mechanisms underlying this rare reaction, which could help to better understand the pathophysiology of sarcoidosis.

[Association of sarcoidosis and Takayasu's disease: A case report]

INTRODUCTION

Vascular lesion of sarcoidosis is rare, it may precede, follow or occur with the symptoms of a Takayasu's disease. Many pathogenic mechanisms (infectious, genetic and immunological) participate in associating those two diseases.

OBSERVATION

We describe the case of a 24-year-old female patient, hospitalized for a check up for mediastinal and cervical adenopathies, nasal obstruction with intermittent claudication in the upper limbs evolving over eight months the clinic examination shows an abolition of radial pulses. The final diagnosis was sarcoidosis with mediastinal and peripheral lymphadenopathy and a nasal lesion associated to a Takayasu arteritis (4 ACR criteria for Takayasu disease). We noticed a good clinical and radiological evolution after one year of oral corticotherapy.

CONCLUSION

The association between sarcoidosis and Takayasu's disease remains rare, thus a differential diagnosis.