Sarcoidosis induced by tocilizumab: a paradoxical event?

To the Editor: Tocilizumab (TCZ) is a monoclonal antibody against the interleukin 6 (IL-6) receptor, used in the treatment of rheumatoid arthritis (RA). We describe a case of onset of sarcoidosis under TCZ therapy in a patient with RA. A 40-year-old woman of North African origin had RA for 12 years. Rheumatoid factor and anticitrullinated antibody were negative. Erosions were absent. Nevertheless, she fulfilled the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA classification criteria (7/10). She was refractory to sulfasalazine and then to methotrexate (MTX). Etanercept was introduced in 2008 and stopped in 2010 because of secondary loss of efficacy. TCZ was initiated in April 2010. The response was good, with the 28-joint Disease Activity Score (DAS28) 0.5 and Health Assessment Questionnaire … Address correspondence to Dr. Cohen, Hopital Lapeyronie, Unite d’Immuno-Rhumatologie, 191 Avenue du Doyen Gaston Giraud, Montpellier 34295, France. E-mail: jd-cohen{at}chu-montpellier.fr