Sarcoidosis-like reaction secondary to adalimumab treatment in a patient with axial spondyloarthritis.

Anti-TNF agents, namely adalimumab, are safe drugs that represent an important arsenal in the treatment of immune-mediated inflammatory diseases. "Paradoxical effects" have been described with their use. A sarcoidosis "like" reaction induced by these agents is rare and is characterized by a systemic granulomatous reaction indistinguishable from sarcoidosis. We present a 55-year-old male patient, with axial spondyloarthritis, treated with with adalimumab. About 17 months under this therapy, he complained of dry cough and wheezing. Chest CT showed a peri-lymphatic and pericisural micronodular pattern and hilo-mediastinal lymph nodes, suggestive of sarcoidosis. Angiotensin converting enzyme was increased. Assuming the hypothesis of a sarcoidosis-like reaction secondary to adalimumab this therapy was discontinued with progressive improvement in the patient's complaints and in the radiological changes.

Interstitial nephritis secondary to treatment with pembrolizumab, a rare complication in two patients with lung adenocarcinoma.

Immune checkpoint inhibitors (ICPi) have become nowadays one of the most widely prescribed anticancer treatments. Pembrolizumab is a highly selective monoclonal immunoglobulin approved as a first-line monotherapy treatment in adult patients with untreated advanced non-small cell lung cancer (NSCLC) with programmed cell death 1 (PD-L1) expression greater than 50% and lack of mutations. ICPi can precipitate immune-related adverse events. Data on the incidence and characteristics of nephrotoxicity from ICPi are limited and caused largely from small case series and oncologic studies. Two patients with a diagnosis of pulmonary adenocarcinoma, undergoing treatment with pembrolizumab who manifested interstitial nephritis secondary to this treatment, are presented below. The growing use of immunotherapy in the treatment of cancer imposes the physician's attention to possible adverse effects.