A Case of Sarcoidosis Associated With Anti-interleukin-17A Therapy
Recommended Citation
Mcintosh J, Jennings JH, Bradley P. A Case of Sarcoidosis Associated With Anti-interleukin-17A Therapy. Am J Respir Crit Care Med 2025; 211:A6138.
Document Type
Conference Proceeding
Publication Date
5-20-2025
Publication Title
Am J Respir Crit Care Med
Abstract
Introduction: Sarcoidosis is a multisystemic inflammatory disorder characterized by the pathological finding of non-caseating granulomas. All organ systems can be affected although common presentations include mediastinal adenopathy, Lung parenchymal disease and cutaneous disease. There have been a number of reports of sarcoidosis and sarcoidosis like granulomatous disease manifesting after treatment with biologic agents such as TNF alpha inhibitors and immune checkpoint inhibitors and is suspected to be due to immune dysregulation. Here, we present a rare case of sarcoidosis with generalized adenopathy and pulmonary nodules presenting after treatment anti-interleukin-17A therapy (anti-IL-17A) for Hidradenitis suppurativa (HS). Case Description 45-year-old female never smoker with history of HS treated with Secukinumab presented to pulmonary clinic for evaluation of Abnormal CT scan. She had a gradual onset and progression of shortness of breath for 2 months. Other symptoms include chest pain, intermittent abdominal pain and intentional weight loss of 30-40 pounds over 6 months. Physical examination was unremarkable. Investigations done by her primary care physician resulted in CT scan with Pulmonary Embolism protocol completed with multiple bilateral pulmonary nodules measuring up to 8 mm, multiple enlarged bilateral subpectoral and axillary lymph nodes. Pulmonary function testing showed normal spirometry and diffusion capacity. Differential diagnosis included malignancy, inflammatory process, and infection. Navigational bronchoscopy was deferred due to size and peripheral location of nodules. PET scan showed Innumerable prominent and hypermetabolic lymph nodes throughout the neck, chest, abdomen, and pelvis. She subsequently underwent ultrasound guided biopsy of left external Iliac chain lymph node which demonstrated necrotizing and non-necrotizing granulomatous inflammation. Investigations for autoimmune conditions and endemic mycosis were negative, and the patient was diagnosed with sarcoidosis associated with anti-interleukin-17A therapy. After discussion of treatment options, patient preferred to monitor with surveillance and on 3 month follow up there was no noted significant symptomatic or radiologic progression in disease with resolution of some pulmonary nodules. DiscussionSecukinumab is a human IgG1 monoclonal antibody that selectively binds and neutralizes protein interleukin-17A. In the literature there have been few cases of sarcoidosis reported manifesting as hilar lymphadenopathy and cutaneous sarcoidosis in patients treated for Psoriatic arthritis. As sarcoidosis is a diagnosis of exclusion it is important to first evaluate and rule out other differential diagnosis such as malignancy, inflammatory, autoimmune or infectious causes. Management options include discontinuation of offending agent, steroids therapy and antimetabolite therapy such as methotrexate. Our case highlights a rare adverse reaction to an interleukin-17A inhibitor.
Volume
211
First Page
A6138
