Infliximab-Induced Granulomatous Vasculitis With Amyloid Deposition in the Tongue of a Patient With Behçet Disease

Iwasaki, Shigeo; Watanabe, Toshiyuki; Tsuji, Takeshi; Otsuka, Takeshi; Makita, Keiko; Fukasawa, Yuichiro; Ishizu, Akihiro

doi:10.1097/rhu.0000000000001567

Cited by 3 publications

(2 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar histologic presentations as this have been reported with cerebral amyloid angiopathy and as rare drug reactions, such as to infliximab. 1,2…”

Section: Answermentioning

confidence: 99%

“…Similar histologic presentations as this have been reported with cerebral amyloid angiopathy and as rare drug reactions, such as to infliximab. 1,2 Insulin-type amyloidosis is a phenomenon in which subcutaneous masses develop at the site of repetitive insulin injections. This type of amyloid is a rare complication of chronic insulin therapy, and most patients present with a hard mass or an "insulin ball" at the site of their insulin injections.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Unexpected Abdominal Fat Pad Biopsy: Answer

Kirby

Grider

Cain

2022

The American Journal of Dermatopathology

View full text Add to dashboard Cite

Granulomatous vasculitis secondary to AIns (insulintype) amyloidosis.Amyloid typing by liquid chromatography-tandem mass spectrometry was positive for AIns (insulin-type) amyloidosis. The histopathologic findings are very unusual for AIns amyloidosis, which previous reports show to be diffuse deposition of pink amorphous material in the dermis and subcutis. However, in this case, insulin-type amyloid presented as a granulomatous vasculitis. The material to which the foreign body reaction was engendered was proven to be amyloid by Congo red staining and by amyloid typing. Stains were negative for fungal vasculitis, and acid-fast bacillus and Fite stains were not performed as the pattern was not that of a mycobacterial infection. Similar histologic presentations as this have been reported with cerebral amyloid angiopathy and as rare drug reactions, such as to infliximab. 1,2 Insulin-type amyloidosis is a phenomenon in which subcutaneous masses develop at the site of repetitive insulin injections. This type of amyloid is a rare complication of chronic insulin therapy, and most patients present with a hard mass or an "insulin ball" at the site of their insulin injections. 3 It is known that insulin-type amyloid is not associated with systemic amyloidosis. 4 The patient in this case report did not present with any skin abnormalities, and instead, his insulintype amyloid was diagnosed during a systemic workup for amyloidosis. 5 This case report brings up a novel histologic and clinical presentation of insulin-type amyloid. The cause of the formation of these insulin-type amyloid masses has not been described, and the awareness of this condition is limited. By our research, this is the second case report that discovered insulin-type amyloid without a concurrent diagnosis of an "insulin ball." More importantly, this is the first case report that found insulin-type amyloid presenting as a deep dermal vasculitis. This finding suggests that pathologists should be aware of this novel presentation of insulin-type amyloid to accurately make this diagnosis. 5

show abstract

“…Similar histologic presentations as this have been reported with cerebral amyloid angiopathy and as rare drug reactions, such as to infliximab. 1,2…”

Section: Answermentioning

confidence: 99%

mentioning

confidence: 99%

Unexpected Abdominal Fat Pad Biopsy: Answer

Kirby

Grider

Cain

2022

The American Journal of Dermatopathology

View full text Add to dashboard Cite

show abstract

Infliximab

2022

Reactions Weekly

View full text Add to dashboard Cite

Vasculitis induced by biological agents used in rheumatology practice: A systematic review

Duran¹,

Paz²,

Santiago³

2021

Arch Rheumatol

View full text Add to dashboard Cite

Objectives: Biological medications have been used with an increasing frequency to treat rheumatological diseases. Autoimmune events can be induced by these drugs, such as psoriasiform lesions, alopecia, lupus and, vasculitis, which more often affects the skin (small-sized vessels) and eventually other organs. In this review, we describe the clinical profile of patients with vasculitis induced by the main biological agents used in rheumatology. Patients and methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The PubMed database was used for searching eligible articles. We included case reports, case series, and letter to the editor of patients on anti-tumor necrosis factor-alpha (anti-TNF-a) molecules, as well as tocilizumab, ustekinumab, secukinumab, rituximab, and abatacept, who had vasculitis induced by these agents. Results: Eighty-one articles were included for final analysis (n=89). Twenty-seven patients were using infliximab, 20 adalimumab, 18 etanercept, seven secukinumab, four certolizumab, four rituximab, three golimumab, three ustekinumab, two abatacept, and one tocilizumab. Unspecific leukocytoclastic vasculitis (LCV) was the most common type of vasculitis (n=37), followed by anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis (n=16). The medication was replaced with another biological molecule in 23 cases, with only four relapses. In six cases, the biological was maintained, but vasculitis worsened/persisted in one case, being necessary drug removal. Conclusion: Infections, infusion reaction, cancer, and autoimmune events are well-known side effects of biological therapy. This review demonstrates that vasculitis is another adverse effect of this type of therapy, particularly the anti-TNF-a molecules, and LCV the most reported type of vasculitis.

show abstract

Infliximab-Induced Granulomatous Vasculitis With Amyloid Deposition in the Tongue of a Patient With Behçet Disease

Cited by 3 publications

References 4 publications

Unexpected Abdominal Fat Pad Biopsy: Answer

Unexpected Abdominal Fat Pad Biopsy: Answer

Infliximab

Vasculitis induced by biological agents used in rheumatology practice: A systematic review

Contact Info

Product

Resources

About