Polychondritis in a Patient With Ankylosing Spondylitis on an Anti–TNF-α Biosimilar Agent

Abstract

A 45-year-old man with HLA-B27-positive ankylosing spondylitis and ulcerative colitis had been on infliximab-dyyb (Inflectra) for 3 years. He presented to the emergency department with 3 days of bilateral auricle pain, redness, and warmth. He had intermittent fever, night sweats, sore throat, and photophobia. On examination, his ears were red, warm, and tender (Fig. , A and B). He was admitted to the hospital and treated with broad-spectrum antibiotics for possible cellulitis. His symptoms did not improve despite antibiotic treatment, and infection was ruled out. He was diagnosed with polychondritis based on clinical manifestation and started on prednisone with methotrexate. Four weeks later, his ear pain and redness had completely resolved. At that time, he was switched from infliximab-dyyb to ustekinumab given the adverse reaction and for better control of his ulcerative colitis. Our patient has previously failed treatments with all the other anti-TNF medications due to lack of efficacy. IL-17α inhibitors were not considered for our patient due to underlying ulcerative colitis.