• Internal medicine · Nov 2023

    Case Reports

    The Onset of IgG4-related Retroperitoneal Fibrosis under Administration of a TNF Inhibitor in a Rheumatoid Arthritis Patient.

    • Takao Ogawa, Kohei Tsujimoto, Hiroshi Shimagami, Chiaki Fukuda, and Toru Hirano.
    • Department of Rheumatology, Nishinomiya Municipal Central Hospital, Japan.
    • Intern. Med. 2023 Nov 1; 62 (21): 325132543251-3254.

    AbstractAn 80-year-old woman with rheumatoid arthritis during treatment with etanercept, a tumor necrosis factor (TNF) inhibitor, showed swelling of the salivary glands and retroperitoneal fibrosis, which was diagnosed as IgG4-related disease. Although some reports have shown the efficacy of TNF inhibitors for IgG4-related disease or retroperitoneal fibrosis, TNF inhibitors sometimes cause paradoxical reactions like psoriasis, and the mechanisms are considered to involve the upregulation of plasmacytoid dendritic cells and IFN-α, which is also common in patients with IgG4-related disease. This is a case report of IgG4-related retroperitoneal fibrosis with the possibility of a rare paradoxical reaction by a TNF inhibitor.

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