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Rheumatology International
Published in: Rheumatology International 5/2009

01-03-2009 | Case Report

Thymic enlargement in a patient with juvenile idiopathic arthritis during etanercept therapy

Authors: Ismail Sari, Omer Binicier, Merih Birlik, Servet Akar, Erkan Yilmaz, Aydanur Kargi, Fatos Onen, Nurullah Akkoc

Published in: Rheumatology International | Issue 5/2009

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Abstract

Tumor necrosis factor (TNF) alpha inhibitors are effective in the treatment of inflammatory rheumatic diseases. Despite their effectiveness, anti-TNF drugs have some drawbacks such as severe adverse effects including infections and possibly lymphoproliferative disorders. In this report we described a case of juvenile idiopathic arthritis patient who developed thymic enlargement (true thymic hyperplasia), mediastinal lymphadenopathy and pleurisy associated with systemic symptoms under Etanercept treatment. The clinical presentation was highly suggestive of malignancy and the patient underwent diagnostic mediastinoscopy with biopsy.
Literature
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Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 295:2275–2285PubMedCrossRef
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Yarom N, Zissin R, Apter S, Hertz M, Rahimi-Levene N, Gayer G (2007) Rebound thymic enlargement on CT in adults. Int J Clin Pract 61:562–568PubMedCrossRef
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Grech AP, Riminton DS, Gabor MJ, Hardy CL, Sedgwick JD, Godfrey DI (2000) Increased thymic B cells but maintenance of thymic structure, T cell differentiation and negative selection in lymphotoxin-alpha and TNF gene-targeted mice. Dev Immunol 8:61–74PubMedCrossRef
Metadata
Title
Thymic enlargement in a patient with juvenile idiopathic arthritis during etanercept therapy
Authors
Ismail Sari
Omer Binicier
Merih Birlik
Servet Akar
Erkan Yilmaz
Aydanur Kargi
Fatos Onen
Nurullah Akkoc
Publication date
01-03-2009
Publisher
Springer-Verlag
Published in
Rheumatology International / Issue 5/2009
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI
https://doi.org/10.1007/s00296-008-0726-1

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