New Onset Isolated Granulomatous Dacryoadenitis During Etanercept Therapy

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Anti-tumor necrosis factor alpha (TNF-α) therapies are used for inflammatory conditions.
• Rarely, these agents can induce sarcoid-like granulomatosis.
• Dacryoadenitis, inflammation of the lacrimal gland, can have various causes.

Observation:

• A 20-year-old woman on etanercept and methotrexate for juvenile idiopathic arthritis presented with eyelid swelling.
• Lacrimal gland enlargement was noted on imaging.
• Biopsy confirmed non-caseating granulomatous dacryoadenitis.

Findings:

• The patient's condition showed significant regression one month after discontinuing etanercept.
• This suggests a direct link between TNF-α antagonist therapy and the dacryoadenitis.
• No systemic sarcoidosis was identified.

Implications:

• This is the first reported case of isolated granulomatous dacryoadenitis associated with TNF-α antagonist therapy.
• Clinicians should consider drug-induced dacryoadenitis in patients on TNF-α inhibitors presenting with similar symptoms.
• Discontinuation of the offending agent may lead to resolution.