Anti-TNF-Related Leukocytoclastic Vasculitis in Ulcerative Colitis: A Case Report

Abstract

Background: The development of drugs directed against tumor necrosis factor (TNF)-α has dramatically modified the therapeutic approach to inflammatory bowel diseases: a larger use of such drugs has also led to a major knowledge about their adverse effects, especially on skin. The aim of this report was to describe a rare steroid-dependent form of leukocytoclastic vasculitis induced by an anti-TNF-α agent in a young woman with ulcerative colitis. Case presentation: A young girl with ulcerative colitis developed a form of leukocytoclastic vasculitis induced by an anti-TNF-α agent. Recurrent palpable purpuric lesions on her legs were the main cutaneous manifestation. Skin lesions were steroid-dependent, but improved after withdrawal of the anti-TNF-α agent and second-line immunosuppressant therapy. Conclusions: The need to develop specific recommendations to guide the use of medications for managing skin reactions induced by anti-TNF-α drugs is herein emphasized.

Clinical Manifestations of Leukocytoclastic Vasculitis, Treatment, and Outcome in Patients with Ulcerative Colitis: A Systematic Review of the Literature

“…The majority of the patients in this review developed LCV as reactive manifestation of UC (95%), and only one patient (5%) developed LCV as a consequence of anti-tumor necrosis factor (TNF-alfa) therapy [12]. This finding is strikingly different from patients with LCV and CD, where LCV attributed to IBD therapy (most commonly infliximab and adalimumab) was found in 60% of patients [8,41].…”

“…Based on pathogenesis, cutaneous manifestations of IBD are categorized as one of the following: reactive cutaneous manifestations, granulomatous cutaneous lesions, dermatosis associated with IBD, or secondary cutaneous manifestation due to complication of IBD treatment [5]. LCV is considered to be a reactive cutaneous manifestation of IBD; however, it may also be secondary to the medication used for its treatment [8,12].…”

“…References to the selected articles were further searched with no additional articles identified. The selection process resulted in the inclusion of a total of 20 articles for this study [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] and a total of 22 cases included in this review. The PRISMA flow-chart is illustrated below (Scheme 1).…”

A rare case of infliximab induced myeloperoxidase-cytoplasmic antineutrophil cytoplasmic autoantibody positive cutaneous vasculitis

“…1,2 Cutaneous vasculitis is a common manifestation of TNF inhibitor use and can be characterized by palpable purpura, ulcerated lesions, erythematous macules, and blisters. 2,3 Literature reports have also noted the induction of newly formed antibodies as a result of TNF inhibitor therapy, with the most cited being double stranded DNA (dsDNA) and antinuclear antibody (ANA). 4,5…”

Leucocytoclastic vasculitis‐like reaction induced by tocilizumab in a patient with rheumatoid arthritis

“…Cutaneous vasculitis has been reported following the use of TNF-α inhibiotrs such as infliximab, etanercept and adalimumab in patients with RA and ulcerative colitis, manifesting as purpura (57%), ulceration (9%) and nodules (9%). 8 The proposed mechanism is type III hypersensitivity caused by vascular deposition of anti TNFα-TNFα immunocomplex. It might be likely that the soluble IL-6R and tocilizumab might form immunocomplex and induced similar cutaneous vasculitis.…”