Paradoxical Reaction to Golimumab: Tumor Necrosis Factor α Inhibitor Inducing Psoriasis Pustulosa

Abstract

Importance: Golimumab is a human monoclonal antibody, used for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Adverse reactions are increasing with this class of medication (tumor necrosis factor α inhibitors). Observations: The authors present a case of a female patient who presented with psoriasis pustulosa after the use of golimumab for rheumatoid arthritis. Conclusions and Relevance: Paradoxically, in this case, golimumab, which is used for psoriasis, induced the pustular form of this disease. We are observing an increasing number of patients who develop collateral effects with tumor necrosis factor α inhibitors, and the understanding of the mechanism of action and how these adverse reactions occur may contribute to avoid these sometimes severe situations.

Paradoxically Psoriasis, developed in a patient using adalimumab for ankylosing spondylitis: Case report

“…However, the mean time for the onset of symptoms has not been established, as the time interval in cases varies significantly. Lesions resolved after discontinuation of therapy in all patients and remained stable while treatment continued 6 . Harrison MJ, Dixon WG, Watson KD, King Y, Groves R, and Hyrich KL conducted a study in RA patients who received anti-TNF therapy to identify those who developed psoriasis and identified 41 cases.…”

“…Skin lesions such as eczema, drug eruptions, drug-induced systemic lupus, dermatomyositis, lymphomatoid papulosis-like rash and psoriasis were reported in 10% of patients who received anti-TNF therapy. Paradoxical psoriasis has an annual incidence of 5% 5,6 . Studies have shown that smoking is the main risk factor for the development of lesions 5 .…”

“…Inhibition of TNF-α may result in an abnormal IFN-α production by PDCs. There is clinical evidence that IFN-α suppresses TNF-a ', causing psoriasis disease activation 6 .…”

Cutaneous side‐effects of biologics in immune‐mediated disorders: A histopathological perspective

“…Biopsies showing acanthosis, spongiform pustules, papillary dermal edema and telangiectasias were also described in patients on golimumab who presented with a widespread pustular eruption, and had the picture of pustular psoriasis on histopathology. 6 Psoriasiform features were also noted on scalp biopsies from patients on infliximab and adalimumab. Patients presented with scaly patches of alopecia.…”