title: Generalized pustulosis induced by adalimumab in a patient with rheumatoid arthritis - a therapeutic challenge.
abstract: Tumor necrosis factor-alpha (TNF-alpha) inhibitors such as adalimumab are increasingly used in the treatment of chronic inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. In Europe, this group of drugs also has been approved for therapy of moderate to severe psoriasis recently. With increased application of adalimumab, the possible adverse effects occurring in the course of treatment steadily gained more attention. Among these, infection and localized skin eruptions are the most common. Usually, the cutaneous symptoms rapidly resolve after discontinuation of the drug. Here, however, we report on a woman with rheumatoid arthritis who developed a therapy-refractory, generalized pustular rash during treatment with adalimumab. After different unsuccessful therapeutic attempts, only a combined treatment with prednisone, methotrexate, and cyclosporinee eventually led to marked improvement. To the best of our knowledge, this is the first report on a generalized, therapy-resistant pustulosis as an adverse effect of adalimumab.
authors.affiliation: Department of Dermatology, Maastricht University Center for Molecular Dermatology, and GROW-School for Oncology and Developmental Biology, University Medical Center Maastricht, The Netherlands. ppg@sder.azm.nl
authors.forename: Martina
authors.initials: M
authors.lastname: Kucharekova
authors.forename: Véronique
authors.initials: V
authors.lastname: Winnepenninckx
authors.forename: Jorge
authors.initials: J
authors.lastname: Frank
authors.forename: Pamela
authors.initials: P
authors.lastname: Poblete-Gutiérrez
mesh_terms: D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001706:Biopsy; D016572:Cyclosporine / Q000627:therapeutic use; D003875:Drug Eruptions / Q000188:drug therapy* / Q000473:pathology*; D004359:Drug Therapy, Combination; D004817:Epidermis / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D000068879:Adalimumab; D008727:Methotrexate