Distinct immunologic and radiographic patterns in etanercept-induced lung injury

Karina Serban, Michael Muzoora, Chadi A. Hage, Tim Lahm

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Nonspecific clinical presentation of non-infectious, immune-mediated pulmonary complications of etanercept therapy makes the diagnosis difficult. While bronchoalveolar lavage fluid (BALF) cell analysis is frequently used in diagnosing drug-induced lung disease, BALF patterns in etanercept-induced lung injury (EILI) are not well established. Furthermore, previous reports of EILI diagnosis relied on transbronchial or surgical lung biopsies. Here, we report two patients who developed pulmonary toxicity after etanercept treatment. Both patients were diagnosed with EILI. While one patient presented with CD4+-predominant lymphocytic alveolitis (consistent with a sarcoid-like pattern), the other patient exhibited a CD8+-predominant pattern (consistent with hypersensitivity pneumonitis-like reaction). The different BAL patterns were accompanied by distinct radiographic findings. Both patients significantly improved after etanercept discontinuation and corticosteroid initiation. We propose that EILI can present with distinct immunologic and radiographic phenotypes. In addition, early BALF analysis with lymphocyte immunophenotyping can further define the underlying immunologic abnormalities, and thereby, avoid more invasive procedures.

Original languageEnglish (US)
Pages (from-to)18-20
Number of pages3
JournalRespiratory Medicine Case Reports
Volume8
Issue number1
DOIs
StatePublished - Jan 22 2013

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Keywords

  • Bronchoalveolar lavage
  • Hypersensitivity pneumonitis
  • Lymphocytic alveolitis
  • Sarcoid-like reaction
  • TNF-α antagonist

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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