Severe erythroderma in a patient under intermittent therapy with efalizumab.
The author presents the case of a 27-year-old man who suffered 2 episodes of erythroderma while on therapy with efalizumab for psoriasis. The first episode, occurred 2 weeks after the first dose, was well controlled without discontinuing the drug. A second erythrodermic flare was observed after 4 weeks following efalizumab reintroduction. In this case, oral methotrexate was administered as monotherapy during 4 months, and then was tapered off and efalizumab again reintroduced for continuous treatment for a period 14 months with excellent results. This second episode of erythroderma was clinically accompanied by a marked hyperkeratosis, blepharitis, and nasal infection due to Staphylococcus aureus. Lymphocytosis and leukocyturia with negative urine culture were also reported in both episodes. As a result, it was concluded that the erythroderma was an adverse reaction to efalizumab that could be solved without treatment discontinuation. The author considered this patient as a good responder to continuous treatment with efalizumab.
Hernandez Garcia
Isabel
I
Servicio Dermatología, Hospital General Básico de la Defensa, L'Alitrà 1, E-46930, Quart de Poblet, Valencia, Spain. mhergar@telefonica.net
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D003873:Dermatitis, Exfoliative / Q000473:pathology*; D003879:Dermatologic Agents / Q000627:therapeutic use; D003875:Drug Eruptions / Q000473:pathology*; D006225:Hand / Q000473:pathology; D006801:Humans; D017488:Hyperkeratosis, Epidermolytic / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy; D012867:Skin / Q000473:pathology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; C472181:efalizumab; D008727:Methotrexate