Anti-TNF Drug-Induced Sarcoidosis in Inflammatory Bowel Diseases: Multicentric Case Series and Literature Review

Sarcoidosis is an inflammatory granulomatous condition and presents overlapping features with inflammatory bowel disease (IBD). Anti-TNF treatment has revolutionized the management of several conditions, including IBD and sarcoidosis. Yet, anti-TNF drugs have been associated with drug-induced sarcoidosis reaction (DISR).

This is a retrospective, international, multicentric case series, including IBD patients with anti-TNF-related DISR. A literature review was performed to identify previously published cases.

Nine new cases of anti-TNF-related DISR in IBD are described with a long follow-up (median 45 months). After literature review, a total of 26 cases were identified. The diagnosis required histological evidence of granulomas in involved organs in all patients. Most patients had a diagnosis of Crohn's disease (n = 19, 73.1%). The culprit drug was infliximab in 15 (57.7%) and adalimumab in 11 (42.3%). The median time to sarcoidosis development was 21 months. Compared to conventional sarcoidosis, extrathoracic involvement was more prevalent (n = 20, 76.7%). Management of DISR consisted of discontinuing anti-TNF treatment in 20 cases (76.9%) and providing specific treatment in 17 cases (65.4%), with favorable outcomes in all cases.

Despite its rarity, DISR may be challenging for IBD patients. Discontinuation of anti-TNF treatment is recommended, and specific treatment is required for moderate-to-severe cases.