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A 58-year-old male patient presented with widespread psoriatic plaques with a Psoriasis Area and Severity Index of 22.6. Due to the lack of benefit from multiple topical agents and methotrexate, he was a candidate for biological therapy. Routine investigations including initial chest radiography and laboratory tests were normal prior to the initiation of therapy. He had no history of lung disease and no contact with tuberculosis patients. Isoniazid prophylaxis was initiated one month prior to adalimumab therapy owing to QuantiFERON®-TB Gold test (Cellestis Limited, Carnegie, Victoria, Australia) positivity. At the end of one month of isoniazid prophylaxis therapy, adalimumab was initiated and the patient received adalimumab for four years without any side effects. Detailed anamnesis revealed that the patient was working as a farmer and plowing fields, and he stated that during the summer, the weather was dry, windy, and dusty in the region he lived.

Sarcoid-like granulomatous reaction in the lung mimicking miliary tuberculosis in a patient receiving adalimumab for psoriasis