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A6556 - Interferon Beta Induced Sarcoidosis
Author Block: D. Becnel1, S. Hadigal2, D. C. Patel3; 1Pulmonary Critical Care, University of Florida, Gainesville, FL, United States, 2University of Florida, Gainesville, FL, United States, 3Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, United States.
Introduction: Interferon therapy has been associated with development of sarcoidosis with the majority of reported cases related to interferon alpha. We present a case of diagnosed after lymphadenopathy was found incidentally on an MRI of the spine in a patient with multiple sclerosis. Case: A 54-year-old Caucasian woman with a medical history significant for multiple sclerosis who presented with hilar and mediastinal lymphadenopathy. She developed left side optic neuritis 7 years prior and was diagnosed multiple sclerosis. She experienced relapsing neurological symptoms for years including transverse myelitis and was treated with multiple agents for multiple sclerosis including interferon beta-1a for several months. Surveillance imaging of her spinal cord incidentally noted mediastinal lymphadenopathy, which was further investigated with a CT Chest. CT scan demonstrated enlargement of bilateral hilar, right paratracheal, and subcarinal lymph nodes with ground glass opacities in the right lower lobe. She denied cough, dyspnea, chest pain, fevers or other constitutional symptoms. She had no history of smoking or significant exposures. She had no family history of malignancy or lung disease. EBUS TBNA of right paratracheal and subcarinal lymph nodes showed epithelioid histiocytes consistent with granulomas. Since interferon therapy had already been stopped along with no significant symptoms there were no indications for initiation of treatment for sarcoidosis. Discussion: Sarcoidosis is a granulomatous disease of unknown etiology that can affect multiple organ systems. Sarcoidosis has been reported to develop after treatment with interferon. Most reported cases of interferon induced sarcoidosis have been related to interferon alpha typically for Hepatitis C treatment. Few cases of have been described. It is important to have sarcoidosis on the differential diagnosis for pulmonary disease in those treated with interferon - either interferon alpha or interferon beta. Approximately 5-10% of patients with sarcoidosis have neurological involvement, and neurological symptoms can be the presenting feature. While this patient had a well-established diagnosis of multiple sclerosis, a similar presentation of neurologic symptoms along with mediastinal adenopathy, neurosarcoidosis should be considered on the differential and ruled out.