Palisaded neutrophilic and granulomatous dermatitis presenting in a patient with rheumatoid arthritis on adalimumab

Stephenson, Sean; Campbell, Shannon; Drew, G. Scott; Magro, Cynthia M.

doi:10.1111/j.1600-0560.2011.01716.x

Cited by 32 publications

(24 citation statements)

References 29 publications

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“…The diseases most commonly reported with PNGD include connective tissue diseases-particularly systemic lupus erythematosus-as well as inflammatory arthritis, hematologic disorders, and rarely infections or medications ( Table 1). Most case reports of medicationinduced PNGD have occurred in the setting of medications used to treat diseases previously reported to occur with PNGD, such as tumor necrosis factor inhibitors for rheumatoid arthritis 17,21,22 and allopurinol in a patient with quiescent chronic myelogenous leukemia. 15 …”

Section: Systemic Associationsmentioning

confidence: 98%

Reactive Granulomatous Dermatitis

Rosenbach

English

2015

Dermatologic Clinics

110

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Section: Systemic Associationsmentioning

confidence: 98%

Reactive Granulomatous Dermatitis

Rosenbach

English

2015

Dermatologic Clinics

110

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“…Granulomatous dermatitis comprises a heterogeneous spectrum ranging from granuloma annulare, IGD, PNGD, IGDR, non-caseating granuloma to sarcoid-like granulomas [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…Twenty-eight adalimumab cutaneous immune reactions have been described, including rheumatoid nodules, non-caseating granulomas of the bone marrow, granuloma annulare [13,[18][19][20][21][22], leukocytoclastic vasculitis, necrotizing vasculitis, cutaneous sarcoidosis, discoid lupus erythematosus, psoriasis, dermatitis herpetiformis and alopecia areata [23]. On the other hand, primary autoimmune diseases can show the same skin lesions as part of their clinical picture [11][12]24].…”

Section: Case Descriptionmentioning

confidence: 99%

Reactive Granulomatous Dermatitis during Anti-TNF Therapy: A Case Report and Review of the Literature

Cassone¹

2017

Clin Med Rev Case Rep

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Tumor Necrosis Factor (TNF)-α blockers have been shown to be highly effective in the treatment of arthritis not responsive to traditional therapy. In parallel, there are an increasing number of reports about the development of cutaneous side effects after the administration of anti-TNF-α agents. Noninfectious cutaneous granulomatous reactions include granuloma annulare, non-caseating granuloma, sarcoid-like granulomatosis and also a wide spectrum of conditions recently unified under the term of reactive granulomatous dermatitis.The majority of the above reported granulomatous dermatitis is associated with an underlying inflammatory disorder, and almost all may be drug-induced. Moreover, a substantial overlap, both in clinical and histologic features, is present between these conditions. We describe a reactive granulomatous dermatitis in a patient with psoriatic arthritis treated with adalimumab, resolved after the TNF-α inhibitor discontinuation, and we summarize the recent case-reports in which reactive granulomatous dermatitis were observed in patients with arthritis receiving various TNF-α inhibitors. Reactive granulomatous dermatitis may be a possible long-term side effect of this class of drugs. Although TNF-α blockers are usually used in the treatment of granulomatous disorders, patients treated with these kinds of drugs should be carefully monitored as, in rare cases, TNF-α inhibitors may induce sufficient cytokine activation to support granuloma formation.

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“…Therefore, the altered antigenicity of dermal collagen, immune complex deposition on the vessel wall, and leukocytoclastic vasculitis caused by TNF-α inhibitors are believed to be the initial events in PNGD pathogenesis. [4,5] PNGD lesions may persist for several months to a few years although most cases are self-limiting. Clinical improvement has been reported in patients administered topical steroids, systemic low-dose steroids, or dapsone.…”

mentioning

confidence: 98%

“…[1,2] Recent case reports suggest an increased incidence of PNGD in rheumatoid arthritis patients administered TNF-α inhibitors. [4,5] TNF-α inhibitors are reported to be paradoxically associated with symptoms of autoimmunity and flares of vasculitis. Therefore, the altered antigenicity of dermal collagen, immune complex deposition on the vessel wall, and leukocytoclastic vasculitis caused by TNF-α inhibitors are believed to be the initial events in PNGD pathogenesis.…”

mentioning

confidence: 98%