| Title: |
EP19 Renal sarcoidosis associated with certolizumab pegol treatment for psoriatic arthritis: a case report |
| Authors: |
Hum, Ryan Malcolm; Kanigicherla, Durga; Ho, Pauline |
| Source: |
Rheumatology Advances in Practice ; volume 4, issue Supplement_1 ; ISSN 2514-1775 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2020 |
| Description: |
Case report - Introduction Sarcoidosis is a systemic granulomatous disease without a known aetiology. Patients can be asymptomatic and do not require treatment. However, for the severe cases of sarcoidosis, anti-tumour necrosis factor-α (TNF-α) agents have been used in addition to corticosteroids and disease modifying anti-rheumatic drugs (DMARDs). Paradoxically, anti-TNF-α treatment has also been shown to induce sarcoidosis in patients with autoimmune diseases, though what is known about the pathogenesis of this phenomenon is limited. We present a case of renal sarcoidosis occurring following Certolizumab Pegol (CZP) treatment in a patient with psoriatic arthritis. Case report - Case description A 55-year-old Caucasian man presented to the emergency department in Jan 2020 with a seizure and was found to have a stage 3 acute kidney injury. He was diagnosed with psoriatic arthritis (PsA) at age 47 and plaque psoriasis at 20. He has no other past medical history. For PsA, he was initially treated with Methotrexate, but this was stopped due to nausea. After failing on sulfasalazine, he was started on Humira (Adalimumab) and low dose Methotrexate, 10mg weekly. Due to lack of efficacy, he switched to Benepali (Etanercept) monotherapy. One year later, he was switched to Cimzia (Certolizumab Pegol) due to worsening disease activity. He was on the treatment for 7 months before presenting with seizures and renal failure. His seizure was caused by uraemia and hypertension secondary to renal failure. He has severe renal dysfunction (eGFR of 8ml/min/1.73m2), but low-level proteinuria (uPCR of 47mg/mmol). A renal biopsy was performed which showed features of non-necrotising interstitial nephritis, with well-formed granulomas & multiple giant cells, consistent with renal sarcoidosis. Infections were excluded including TB. He was started on high dose prednisolone 80mg daily, a modest improvement in creatinine was observed from 636µmol/L (eGFR 8ml/min/1.73m2) on admission to 526µmol/L (eGFR 10ml/min/1.73m2) on ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/rap/rkaa052.018 |
| Availability: |
https://doi.org/10.1093/rap/rkaa052.018; http://academic.oup.com/rheumap/article-pdf/4/Supplement_1/rkaa052.018/34103851/rkaa052.018.pdf |
| Rights: |
http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.EE3A985C |
| Database: |
BASE |