Cutaneous polyarteritis nodosa localized to the arm receiving an infusion of abatacept

Cutaneous polyarteritis nodosa localized to a region of lymphedema secondary to Streptococcus viridans cellulitis and multiple surgeries

“…Both infections and subsequent tissue trauma probably damaged lymphatic vessels . Similarly, a case of localized CPAN to the left arm was found after a patient had repeated infusions of abatacept to the area, possibly causing tissue and vessel trauma as well as disrupting the lymphatics and/or altering an immune response because of large local dose of abatacept …”

“…10 Similarly, a case of localized CPAN to the left arm was found after a patient had repeated infusions of abatacept to the area, possibly causing tissue and vessel trauma as well as disrupting the lymphatics and/or altering an immune response because of large local dose of abatacept. 13 All of the aforementioned cases emphasize the importance of lymph flow and how disruptions in it, may predispose to the development of CPAN. Immune-complex disease is initiated when antigen and antibody are in a one to one ratio, or slight excess of antigen.…”

“…Prolonged use of minocycline is another well‐accepted etiology . Rare reports of localized CPAN exist affecting lower leg lymphedema, skin affected by streptococcal necrotizing cellulitis, post radiation morphea, scar lymphedema following exposure to silicone breast implant and in a forearm exposed to infusion of abatacept . These phenomenon all point to local defect in immunity such as lymphatic failure (Table ).…”

Medium-vessel vasculitis presenting as multiple leg ulcers after treatment with abatacept

“…Reported cutaneous reactions after treatment with abatacept, including rheumatoid vasculitis, cutaneous polyarteritis nodosa localized to the infusion site, pyoderma gangrenosum, erythema elevatum diutinum, psoriasis, and Sweet syndrome, have mostly been described in patients with rheumatoid arthritis. 2 , 3 , 4 , 5 …”