Chilblain lupus induced by TNF-α antagonists: a case report and literature review

Giraldo, Walter Alberto Sifuentes; Lana, María Ahijón; Villanueva, María Jesús García; García, Carmen González; Díaz, Mónica Vázquez

doi:10.1007/s10067-011-1924-x

Cited by 25 publications

(19 citation statements)

References 22 publications

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“…A high incidence of autoantibodies including ANAs, anti-dsDNA antibodies, anticardiolipin antibodies, anti-histone antibodies, anti-nucleosome antibodies and antineutrophil cytoplasmic antibodies positivity was noted in these patients (100,101). Several recent case reports describe drug-induced lupus in patients treated with anti-TNF biologicals (102)(103)(104)(105)(106)(107)(108)(109)(110)(111)(112). While manifestations were varied, a common feature was the presence of autoantibodies.…”

Section: Autoimmune Adverse Eventsmentioning

confidence: 99%

Safety of Anti-Tumor Necrosis Factor Therapies in Arthritis Patients

Nanau¹,

Neuman

2014

J Pharm Pharm Sci

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Purpose. Inflammatory and rheumatic arthritis remain leading causes of disability worldwide. The arthritis therapeutic area commands the largest market for the prescription of biological and non-steroidal anti-inflammatory drugs (NSAID). Yet biotechnology and pharmaceutical companies conducting research and providing therapeutics in this area frequently face challenges in patient safety. The purpose of our study was to assess safety of anti-tumor necrosis factor therapies in arthritis patients. Methods: The present study systematically reviews adverse events of biologicals alone or in the presence of NSAIDs and other immunosuppressant therapeutics such as disease-modifying antirheumatic drugs (DMARD). We assessed the rheumatology literature that included clinical trials with anti-tumor necrosis factor (TNF) biologicals and case reports published between 2010 and 2014. Results: Currently approved anti-TNF biologicals in arthritis include the monoclonal antibodies infliximab, adalimumab, certolizumab pegol and golimumab, and the fusion protein etanercept. The most frequently-reported adverse event was infection. We grouped the adverse reactions as immune-mediated, hypersensitivity syndrome reactions including cutaneous and hepatic manifestation, neurological, hematological, and malignancy. Discussion: Most adverse events are due to the failure of host immunological control, which involves susceptibility to the drug itself, or de novo infection or reactivation of a latent bacterial or viral infection, often with a different expression of disease. Drug-induced liver injury associated with anti-TNF biologicals must be kept in mind when evaluating patients with increased liver enzymes. Conclusion: Risk assessment in individuals undergoing treatment with biologicals represents a step towards achieving a personalized medicine approach to identify those patients that will safely benefit from this therapeutic approach. Patients and physicians must be alert of anti-TNF agents as potential causes of drug-induced liver injury and monitor the therapies. Personalizing therapeutic pharmacovigilance promises to optimize benefits while minimizing side effects.This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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Section: Autoimmune Adverse Eventsmentioning

confidence: 99%

Safety of Anti-Tumor Necrosis Factor Therapies in Arthritis Patients

Nanau¹,

Neuman

2014

J Pharm Pharm Sci

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“…TNF inhibitors can induce this disease [41]. However, lupus pernio secondary to sarcoidosis responded swiftly to adalimumab in one case report [42].…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab reverses cerebral vasculopathy in a patient with homozygous SAMHD1 mutation

Henrickson

Wang

2017

Clin Rheumatol

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An auto-inflammatory syndrome consequent to SAMHD1 mutations involves cerebral vasculopathy characterized by multifocal stenosis and aneurysms within large arteries, moyamoya, chronic ischemia, and early-onset strokes (SAMS). While this condition involves the innate immune system, additional clinical features mimic systemic lupus erythematosus. Mutations in this gene can also cause a subset of the rare genetic condition Aicardi-Goutières syndrome. To date, no established therapy successfully prevents disease progression. We report a corticosteroid-dependent SAMS patient, a 19-year-old male of Old Order Amish ancestry, with diffuse cerebral arteriopathy identified through contrast brain magnetic resonance arteriography (MRA) and MRI. He received subcutaneous adalimumab every 2 weeks for 9 months with minimal response. Then, he started intravenous tocilizumab (6 mg/kg/dose) every 4 weeks. He sustained steadily normalizing cerebral vasculopathy and lab abnormalities resolved, allowing prednisone reduction. We conclude that the cerebral vasculopathy of the homozygous SAMHD1 mutation-mediated auto-inflammatory disease SAMS responded favorably to tocilizumab infusion therapy.

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“…There are no pathognomonic histological findings for idiopathic chilblains, but many studies describe superficial and deep perivascular lymphocytic infiltrates, with vessel wall and papillary dermal edema [ 1 , 5 - 7 ]. It has been suggested that idiopathic chilblains may be distinguished from secondary lesions seen in lupus by the presence of spongiosis, perieccrine inflammation, and dermal edema [ 1 ] in idiopathic lesions, whereas vacuolation of basal cells is more commonly seen in lupus erythematosus lesions.…”

Section: Discussionmentioning

confidence: 99%

Chilblains in Southern California: two case reports and a review of the literature

Gordon¹,

Arikian

Pakula

2014

J Med Case Reports

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IntroductionChilblains or perniosis is an acrally located cutaneous eruption that occurs with exposure to cold. Chilblains can be classified into primary and secondary forms. The primary or idiopathic form is not associated with an underlying disease and is clinically indistinguishable from the secondary form. The secondary form is associated with an underlying condition such as connective tissue disease, monoclonal gammopathy, cryoglobulinemia, or chronic myelomonocytic leukemia. Histopathology cannot accurately help distinguish the primary from secondary forms of chilblains. This article will raise the awareness of chilblains by presenting two unusual case reports of chilblains in men from Southern California with discussion of the appropriate evaluation and treatment of this condition.Case presentationsCase 1A 56-year-old Caucasian man presented in January to a Southern California primary care clinic with a report of tingling and burning in both feet, followed by bluish discoloration and swelling as well as blistering. He had no unusual cold exposure prior to the onset of his symptoms. He had a history of “white attacks” in his hands consistent with Raynaud’s phenomenon. His symptoms gradually resolved over a 3-week period.Case 2A 53-year-old Caucasian man also presented to a Southern California clinic in January with a 3-week history of painful tingling in his toes, and subsequent purplish-black discoloration of the toes in both feet. His symptoms occurred 1 week after a skiing trip. He had partial improvement with warming measures. His symptoms resolved 2 weeks after his initial presentation.ConclusionsChilblains is a relatively uncommon entity in warmer climates but can present during the winter months. Primary care providers in warmer climates such as Southern California in the USA may be unfamiliar with its presentation. It can be diagnosed clinically by the appearance of typical lesions during the cold damp season. Through a thorough history, physical examination and selected laboratory evaluation, underlying connective tissue disease or a mimic such as vasculitis or cutaneous leukemia can be excluded.

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Chilblain lupus induced by TNF-α antagonists: a case report and literature review

Cited by 25 publications

References 22 publications

Safety of Anti-Tumor Necrosis Factor Therapies in Arthritis Patients

Safety of Anti-Tumor Necrosis Factor Therapies in Arthritis Patients

Tocilizumab reverses cerebral vasculopathy in a patient with homozygous SAMHD1 mutation

Chilblains in Southern California: two case reports and a review of the literature

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