Pulmonary sarcoidosis and latent tuberculosis in a patient with psoriasis treated with adalimumab.

Tumor necrosis factor (TNF) inhibitors are powerful biologic medications that have been used successfully in the treatment of a variety of inflammatory conditions, including psoriasis. Although TNF inhibitors are generally well tolerated, their use increases the risk of infections such as tuberculosis (TB), and paradoxically, they have been associated with development of sarcoidosis. We report the case of a 54-year old man with plaque psoriasis who developed a positive TB test and pulmonary sarcoidosis after 12 months of adalimumab treatment. After stopping adalimumab, his psoriasis worsened and he was started on ustekinumab and narrowband UVB, with improvement in symptoms. We provide a review of the literature and discuss treatment challenges.

Type two or localized endobronchial non-Hodgkin lymphoma.

We present chest x-ray, chest CT, and FDG PET images of a patient diagnosed with endobronchial lymphoma. The commonly involved thoracic structures in non-Hodgkin lymphoma are mediastinal lymph nodes. Non-Hodgkin lymphoma involving the tracheobronchial tree is rare. Localized primary endobronchial lymphoma confined to the tracheobronchial tree with no dissemination classified as type-2 is extremely rare. This is a report describing the type-2 endobronchial DLBCL. The patient also had a history of rheumatoid arthritis and was treated with methotrexate for 10 years. The other interesting aspect of this case is its association with rheumatoid arthritis and methotrexate treatment. Although there are reports documenting this type of association in the literature, there is almost no documented evidence of this association specifically with type-2 endobronchial non-Hodgkin lymphoma.