Sacroiliitis after use of oral isotretinoin - association with acne fulminans or adverse effect?

Abstract

Acne fulminans is a rare and severe form of acne that may evolve from acne vulgaris, especially in male adolescents, or occur as an adverse effect of oral isotretinoin. Arthritis is a serious clinical manifestation when the musculoskeletal system is compromised by AF and has been reported as a rare adverse effect of isotretinoin. Involvement of the sacroiliac joints occurs in 21% of acne fulminans cases. We present the case of a 18-year-old male patient in whom acne fulminans evolved from acne vulgaris grade IV and after inflammation resolution started treatment with oral isotretinoin. Within a 30-day period of retinoid treatment he presented with back pain followed by rapid, progressive inability to deambulate.

Isotretinoin‐induced arthritis mimicking both rheumatoid arthritis and axial spondyloarthritis

“…The underlying mechanism is thought to be related to the detergent‐like properties of isotretinoin that might induce liposomal membrane solubilization and cause the destruction of synovial cells and resulting arthritis . Some authors have discussed whether isotretinoin can cause sacroiliitis or whether it triggers sacroiliac inflammation in genetically susceptible persons . Our patient was HLA‐B27 negative, his sacroiliac inflammation resolved with the discontinuation of isotretinoin and anti‐inflammatory treatment, and the healing was proven with MRI.…”

“…Isotretinoin has adverse skeletal and rheumatologic effects. Unilateral or bilateral sacroiliitis associated with isotretinoin usage is well known due to recently reported cases. Isotretinoin‐induced peripheral arthritis has also been reported.…”

Dramatic Response to Methyl Prednisolone of Sacroiliitis due to İsotretinoin Theraphy: A Case Report

“…İsotretinoine bağlı gelişen sakroiliit, unilateral veya bilateral olabilir, nadir görülür. Literatürdeki bilgiler olgu sunumları ile sınırlıdır (13,14). Hastalarda isotretinoin kullanımı ile yeni başlayan şiddetli ağrı olması ve bu ağrının isotretinoin tedavisinin kesilmesi ile kaybolması, diğer etiyolojik nedenler ekarte edildiğinde tanıda yol gösterici olabilir.…”

“…Sakroiliit gelişiminde altta yatan mekanizma halen net olarak açıklanamamaktadır. HLA-B27 pozitif olan ve isotretinoin kullanan hastalarda sakroiliit daha fazla görülmektedir (7,13). 2015 yılında yapılan bir çalışmada, isotretinoinin kullanan olguların %23,1'inde spondilartropati geliştiği bildirilmektedir (14).…”

Acne fulminans in the course of oral isotretinoin treatment. Presentation of cases

“…In the event of bone pains, infections or cancer should be ruled out first. The final diagnosis has to be based on biopsy results [7,8].…”