Henoch-Schönlein Purpura After Etanercept Therapy for Psoriasis

Abstract

Etanercept is a recombinant dimeric fusion protein consisting of a tumor necrosis factor-␣ receptor ligand-binding region linked to the Fc portion of human IgG. It is approved for use in the treatment of rheumatoid arthritis, ankylosing spondylitis, juvenile rheumatoid arthritis, psoriasis, and psoriatic arthritis. Since 1998, there have been reports of vasculitic adverse events, including necrotizing vasculitis and leukocytoclastic vasculitis. In addition, the adverse events reporting system of the U.S. Food and Drug Administration has recorded 35 cases of leukocytoclastic vasculitis, 20 after etanercept therapy and 15 after infliximab. Most cases of cutaneous vasculitis describe development of symptoms within 3 months of etanercept use. In only one case report was direct immunofluorescence performed on tissue and no specific immunoreactivity found. We describe the first case of Henoch-Schönlein purpura with acute renal failure associated with increase in etanercept dose after 11 months of use for treatment of psoriasis. Discontinuation of the drug and treatment with a course of systemic steroids led to the complete resolution of the vasculitis and improvement of renal function. Vasculitis occurring even during chronic use of antitumor necrosis factor agents must be considered as possibly related to the therapy.

Use of Anti TNF-α Therapy in Systemic Vasculitis

“…In fact, these agents can induce autoimmune syndromes like vasculitis e.g. Henoch-schönlein purpura [73]. Collectively, we encourage clinicians, in the field of taking care of vasculitis patients, to raise their collaboration level; with the aim to reach a better evidence-based clinical practice.…”

ANCA‐positive crescentic glomerulonephritis in a patient with rheumatoid arthritis treated with anti‐tumor necrosis factor alpha

“…The patient did not have other criteria to make a diagnosis of Henoch‐Schönlein purpura (HSP). There are a few case reports describing HSP, a variant of IgA nephropathy, following treatment with etanercept in patients with RA . More recently, a case report was published where IgA nephropathy was diagnosed in a patient with psoriasis treated with adalimumab …”

Glomerulonephritis in Two Patients with SpA Treated with TNF-α Blockers and a Review of the Literature

“…Renal abnormalities and kidney biopsy results are depicted in Τable 1 according to underlying disease and to the anti-TNF-α agent implicated. [8][9][10][11][12][13][14] Renal Involvement in the SpA Axial SpA-AS can be accompanied by extraarticular manifestations primarily of the cardiovascular and respiratory system. Renal disease is exceptionally rare.…”