Reactive Granulomatous Dermatitis during Anti-TNF Therapy: A Case Report and Review of the Literature

Abstract

Tumor Necrosis Factor (TNF)-α blockers have been shown to be highly effective in the treatment of arthritis not responsive to traditional therapy. In parallel, there are an increasing number of reports about the development of cutaneous side effects after the administration of anti-TNF-α agents. Noninfectious cutaneous granulomatous reactions include granuloma annulare, non-caseating granuloma, sarcoid-like granulomatosis and also a wide spectrum of conditions recently unified under the term of reactive granulomatous dermatitis.The majority of the above reported granulomatous dermatitis is associated with an underlying inflammatory disorder, and almost all may be drug-induced. Moreover, a substantial overlap, both in clinical and histologic features, is present between these conditions. We describe a reactive granulomatous dermatitis in a patient with psoriatic arthritis treated with adalimumab, resolved after the TNF-α inhibitor discontinuation, and we summarize the recent case-reports in which reactive granulomatous dermatitis were observed in patients with arthritis receiving various TNF-α inhibitors. Reactive granulomatous dermatitis may be a possible long-term side effect of this class of drugs. Although TNF-α blockers are usually used in the treatment of granulomatous disorders, patients treated with these kinds of drugs should be carefully monitored as, in rare cases, TNF-α inhibitors may induce sufficient cytokine activation to support granuloma formation.