Correspondence |

Pyoderma Gangrenosum in a Patient With Seronegative Rheumatoid Arthritis During Therapy With Adalimumab: Toxic Effects of Adalimumab or Failure of Adalimumab to Prevent the Onset of This Phenomenon?

Martin Stichenwirth, MD; Elisabeth Riedl, MD; Hubert Pehamberger, MD; Gerhard Tappeiner, MD
Arch Dermatol. 2008;144(6):817-818. doi:10.1001/archderm.144.6.817.
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Adalimumab is a recombinant human IgG1 monoclonal antibody specific for tumor necrosis factor α (TNF-α). Pharmacologic blockade of TNF-α has proven beneficial in a variety of chronic inflammatory conditions, including rheumatoid arthritis and psoriasis.1 It has also been successfully used in the treatment of pyoderma gangrenosum,2 a noninfectious skin disorder frequently associated with rheumatoid arthritis, ulcerative colitis, or hematologic malignancy. A growing number of adverse skin reactions to anti–TNF-α agents, including local reactions at the injection site, nonspecific rashes, isolated cases of bullous skin lesions, leukocytoclastic vasculitis,3 and erythema multiforme,4 have been reported. Moreover, development of psoriasis5 during anti–TNF-α treatment has been observed.

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Figure 1.

Patient with pyoderma gangrenosum that developed during adalimumab treatment. Photographs show continually progressing lesions after initial debridement on the face (A), right shoulder (B), and left upper arm (C).

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Figure 2.

Lesions showed rapid improvement under treatment with methylprednisolone and cyclosporine A. Photographs show the face (A), right shoulder (B), and left upper arm (C) of the same patient shown in Figure 1 after 12 weeks of follow-up.

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