title: A case of peripheral neuropathy and skin ulcer in a patient with rheumatoid arthritis after a single infusion of tocilizumab.
abstract: We report a case of peripheral neuropathy and skin ulcer in a patient with rheumatoid arthritis (RA) who received tocilizumab. A 65-year-old woman with a 20-year history of RA participated in a tocilizumab clinical trial. She received a single dose of 8 mg/kg tocilizumab intravenously. The following day the patient started to experience numbness and purpura in all four extremities. The purpura of her left lower limb became necrotic, and a skin ulcer appeared 3 weeks later. Steroid-pulse treatment was initiated 12 weeks after tocilizumab administration, with the result that the numbness improved, and the skin ulcers showed complete epithelialization.
authors.affiliation: Department of Orthopedic Surgery, Anjo Kosei Hospital, 28 Higashihiroaze, Anjo-cho, Anjo, Aichi 466-8602, Japan. sugiuraf@kosei.anjo.aichi.jp
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Sugiura
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Kojima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Oguchi
authors.forename: Shirou
authors.initials: S
authors.lastname: Urata
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sakakibara
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Norihiro
authors.initials: N
authors.lastname: Nishimoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D061067:Antibodies, Monoclonal, Humanized; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001792:Blood Platelets / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D009336:Necrosis; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*; D012883:Skin Ulcer / Q000139:chemically induced* / Q000473:pathology; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D015850:Interleukin-6; D042461:Vascular Endothelial Growth Factor A; D005340:Fibrinogen; D002097:C-Reactive Protein; C502936:tocilizumab