Bilateral Vocal Cord Carcinoma in a Sarcoidosis Patient during Infliximab Therapy

Introduction. Although the role of TNF-α in tumor development is not fully understood, an increased risk of malignancy with TNF-α-inhibitors, such as infliximab, has been suggested. Case Presentation. We present a 54-year-old nonsmoking female sarcoidosis patient. After seven months of infliximab therapy a T1aN0M0 larynx carcinoma of the right vocal cord was found and excised. Within a year, whilst still on treatment, a second larynx carcinoma of the opposite vocal cord appeared. Discussion. A bilateral vocal cord tumor is rare, especially in a never smoker. Evidence on the role of infliximab in carcinogenesis is inconclusive. To date, there are no follow-up studies evaluating malignancy risk of infliximab therapy in sarcoidosis patients. No studies in other diseases focus on laryngeal carcinomas during infliximab use. We argue that infliximab treatment might have attributed to the rapid progression of vocal cord carcinomas in this patient with an a priori low risk tumor profile. This case illustrates that caution remains warranted in patients with previous malignancies when considering initiation of TNF-α-inhibitors. 1. Introduction Tumor necrosis factor-α (TNF-α) inhibitors such as infliximab are used in treatment of various diseases like rheumatoid arthritis, Crohn’s disease, ankylosing spondylitis, and psoriasis. Today, infliximab is also an upcoming therapeutic option for cases of severe pulmonary and/or extrapulmonary sarcoidosis refractory to standard therapy [1]. Besides its key role in inflammation, TNF-α has several qualities that may have impact on carcinogenesis, tumor growth, and the time point of clinical detection of malignancies. Although the role of TNF-α in tumor development is not fully understood, an increased risk of malignancy with TNF-α-inhibitors has been suggested in other diseases than sarcoidosis [2–4]. 2. Case Report We present the case of a 54-year-old female who was diagnosed five years earlier with Scadding stage II sarcoidosis. Diagnosis was biopsy proven with noncaseating granulomas found in endobronchial biopsies. Pulmonary complaints were dyspnoea on exertion and coughing. Moreover, her sarcoidosis was accompanied by severe small fiber neuropathy which was invalidating in everyday life. Other extrapulmonary symptoms were extrathoracic lymph nodes. A trial of prednisone failed due to severe psychological side effects. The severity of her symptoms and established disease activity on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) scan prompted the decision to initiate infliximab therapy. Infliximab was