Pulmonary and Extrapulmonary Noncaseating Granulomas Due to Tumor Necrosis Factor-Alpha Blocker Therapy

INTRODUCTION: Anti-TNF-α agents have been used to treat diseases characterized by the presence of noncaseating granulomas (NCGs), such as sarcoidosis. However, recent cases of NCGs classified as sarcoid-like granulomatosis occurring during treatment with TNF- α blockers, mainly etanercept, have been described. This seemingly paradoxical behavior has yet to be explained. We report a case of both pulmonary and extra-pulmonary NCGs in a patient treated with the anti TNF-α agents etanercept and adalimumab.