Multiple bilateral eyelid molluscum contagiosum lesions associated with TNFalpha-antibody and methotrexate therapy.
OBJECTIVE
To demonstrate a patient developing multiple bilateral eyelid molluscum contagiosum lesions after initiation of TNFalpha-antibody therapy for rheumatoid arthritis.


METHODS
Single interventional case report.


METHODS
Clinical, histopathologic, and immunologic-serological findings are presented.


RESULTS
A 67-year-old patient with a 5-year history of rheumatoid arthritis had been treated with prednisone and methotrexate for the last 5 years. After initiation of additional TNFalpha-antibody treatment, complaints from rheumatoid arthritis subsided, but multiple bilateral molluscum contagiosum lesions of upper and lower eyelids occurred despite normal or only slightly reduced CD(4) (420-178/ microl) and CD(8) counts (143-58/microl). Histopathologic evaluation of the excised warts confirmed the clinical diagnosis. Under continued therapy, the warts have been recurring for 12 months.


CONCLUSIONS
TNFalpha-antibody treatment for rheumatoid arthritis may compromise the host response to molluscum contagiosum, especially if methotrexate is given additionally. Patients should be informed about this potential complication.
Department of Ophthalmology and University Eye Hospital Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany. claus.cursiefen@augen.med.uni-erlangen.de
Claus
C
Cursiefen
Mathias
M
Grunke
Claudia
C
Dechant
Christian
C
Antoni
Anselm
A
Jünemann
Leonard M
LM
Holbach
D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D004359:Drug Therapy, Combination; D015828:Eye Infections, Viral / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D005141:Eyelid Diseases / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D000069285:Infliximab; D008727:Methotrexate / Q000009:adverse effects*; D008976:Molluscum Contagiosum / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D009894:Opportunistic Infections / Q000139:chemically induced / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*; D014860:Warts / Q000139:chemically induced / Q000473:pathology / Q000601:surgery
D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D008727:Methotrexate