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.
Cursiefen
Claus
C
Department of Ophthalmology and University Eye Hospital Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany. claus.cursiefen@augen.med.uni-erlangen.de
Grunke
Mathias
M
Dechant
Claudia
C
Antoni
Christian
C
Jünemann
Anselm
A
Holbach
Leonard M
LM
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