Thorax 58:278-279 doi:10.1136/thorax.58.3.278
  • Case Report

Pulmonary granulomas after tumour necrosis factor alpha antagonist therapy

  1. S R Vavricka1,
  2. T Wettstein1,
  3. R Speich1,
  4. A Gaspert2,
  5. E B Bachli1
  1. 1Department of Medicine, University of Zurich, Switzerland
  2. 2Department of Pathology, University of Zurich, Switzerland
  1. Correspondence to:
    Dr E B Bachli, Department of Medicine, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland;
  • Accepted 26 February 2002


Tumour necrosis factor α (TNFα) antagonists are an established therapeutic option in Crohn's disease and rheumatoid arthritis. In recently published studies these agents have been used with great success, but little is known about any side effects or long term consequences. They increase the frequency of infections with mycobacteria, where TNFα is thought to be an important host defence factor. We describe one patient who was treated with TNFα antagonists and later developed pulmonary granulomas with caseating necrosis without detection of mycobacteria or any other pathogens. Possible mechanisms involved in this newly recognised side effect are discussed.