Imiquimod: potential risk of an immunostimulant.
A 19-year-old woman with severe HLA B27 spondyloarthropathy whose disease was controlled on cyclosporin, methotrexate and prednisolone had human papillomavirus infection and developed cervical dysplasia and a large number of cutaneous and vulval warts. These were not responsive to cryotherapy, salicylic acid or cimetidine, so she was treated with topical imiquimod 5% cream. Two weeks after starting this treatment she had a significant flare of her spondyloarthropathy. She was so ill that she stopped using the imiquimod cream. She had full resolution of her warts after 3 weeks' treatment with imiquimod cream, but her spondyloarthropathy took more than 3 months to improve, despite significant augmentation of her immunosuppression. This case highlights the potential risk of using imiquimod cream (an immunostimulant) in a patient who has a condition requiring immunosuppression, such as autoimmune disease or an organ transplant.
Benson
Elizabeth
E
Department of Immunopathology, ICPMR, Westmead Hospital and Department of Medicine, University of Sydney, Westmead Hospital, Westmead, New South Wales 2145, Australia. elizab@westgate.wh.usyd.edu.au
D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000293:Adolescent; D000634:Aminoquinolines / Q000009:adverse effects*; D004336:Drug Antagonism; D005260:Female; D006801:Humans; D000077271:Imiquimod; D007166:Immunosuppressive Agents / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000188:drug therapy; D012008:Recurrence; D012871:Skin Diseases / Q000188:drug therapy; D013166:Spondylitis / Q000188:drug therapy / Q000503:physiopathology*; D002578:Uterine Cervical Dysplasia / Q000188:drug therapy; D014845:Vulvar Diseases / Q000188:drug therapy; D014860:Warts / Q000188:drug therapy
D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D007166:Immunosuppressive Agents; D000077271:Imiquimod