Severe Attack of Henoch-Schönlein Purpura With Neurological Involvement During Adalimumab Treatment for Crohn’s Disease

Abstract

Tumour necrosis factor-α [TNF-α] inhibitors have revolutionised the management of chronic inflammatory conditions. A number of cutaneous adverse events have been reported with TNF inhibition, including vasculitis. Most reactions are mild and rarely warrant treatment withdrawal. Here we describe a patient with Crohn’s disease treated with adalimumab in whom severe multivisceral Henoch-Schönlein purpura developed, including neurological involvement, requiring definitive TNF blocker withdrawal.

Henoch Schonlein purpura in pediatric patients with inflammatory bowel disease: A case series

“…The four patients with atypical, prolonged courses of HSP were on anti‐TNF therapies, suggesting that anti‐TNF medications may play a role in triggering or prolonging IgA vasculitis in these patients. This hypothesis is supported by a recent review of 12 cases of new‐onset HSP in patients on anti‐TNF therapy, seven of whom had IBD 9 . Park et al 10 have previously suggested eosinophil activation in response to anti‐TNF agents as a possible pathogenic explanation for the development of HSP.…”

“…This hypothesis is supported by a recent review of 12 cases of new-onset HSP in patients on anti-TNF therapy, seven of whom had IBD. 9 Park et al 10 have previously suggested eosinophil activation in response to anti-TNF agents as a possible pathogenic explanation for the development of HSP. Further studies are necessary to confirm this hypothesis and explore mechanisms for anti-TNF therapies in the pathogenesis of HSP.…”

“…However, more severe cases including HSP with neurologic involvement while on adalimumab have been reported. 9 In severe cases, discontinuation of anti-TNF therapy and initiation of other therapies should be considered.…”

“…For two patients maintaining anti‐TNF therapy, mycophenolate mofetil was an effective therapy in controlling the HSP. However, more severe cases including HSP with neurologic involvement while on adalimumab have been reported 9 . In severe cases, discontinuation of anti‐TNF therapy and initiation of other therapies should be considered.…”

IgA vasculitis update: Epidemiology, pathogenesis, and biomarkers

“…Further, biological agents, especially TNF-α blockers ( adalimumab , infliximab , etc.) are also commonly suspicious drugs, and case reports described the occurrence of IgAV with rare neurological involvement in Crohn’s patients after adalimumab treatment ( 131 ). Studies have suggested that TNF-α blockers can stimulate the formation of anti-tumor necrosis factor or tumor necrosis factor-containing immune complexes in small vessels and subsequently activating the complement pathway to induce vasculitis ( 132 ).…”