title: Interstitial granulomatous drug reaction to anakinra.
abstract: Interstitial granulomatous drug reactions are an uncommon entity presenting as asymptomatic, annular, erythematous to violaceous plaques. The incidence of such reactions has been increasing with the use of biologic agents. We report, to the best of our knowledge, the first such reaction to the interleukin (IL)-1 inhibitor anakinra. Our patient presented with pink dermal plaques and nodules in the periaxillary region which resolved with discontinuation of anakinra and recurred upon restarting anakinra. Biopsy revealed a diffuse dermal infiltrate of lymphocytes and histiocytes with interspersed neutrophils and eosinophils. Fragmentation and degeneration of collagen and elastic fibers was also present. Withdrawal of anakinra led to complete resolution of the lesions. Interstitial granulomatous drug reactions are increasing in frequency and we add anakinra to the list of causative agents.
authors.affiliation: Department of Dermatology, Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, Pennsylvania, USA. cregula@hmc.psu.edu
authors.forename: Christie G
authors.initials: CG
authors.lastname: Regula
authors.forename: Jeannie
authors.initials: J
authors.lastname: Hennessy
authors.forename: Loren E
authors.initials: LE
authors.lastname: Clarke
authors.forename: David R
authors.initials: DR
authors.lastname: Adams
authors.forename: Michael D
authors.initials: MD
authors.lastname: Ioffreda
authors.forename: Emmy M
authors.initials: EM
authors.lastname: Graber
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Helm
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D005260:Female; D006099:Granuloma / Q000209:etiology* / Q000473:pathology; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D018501:Antirheumatic Agents; D053590:Interleukin 1 Receptor Antagonist Protein