Interstitial granulomatous dermatitis in rheumatoid arthritis responsive to etanercept.
Interstitial granulomatous dermatitis (IGD) is a rare dermatological condition presenting as erythematous plaques. It may be associated with drug-related adverse reactions and autoimmune diseases. Recent cases of IGD have been reported in rheumatoid arthritis (RA) patients treated with biologic agents. We report a case of RA patient with persistent erythematous plaques who did not respond to traditional disease-modifying anti-rheumatic drugs with a persistent skin condition of erythematous plaque eruptions. A biopsy showed a homogeneous inflammatory infiltrate in the deep dermis composed of large epithelioid histiocytes with occasional granulocytes, leading us to consider a diagnosis of IGD. The cutaneous lesions disappeared after a 3-month treatment with the tumour necrosis factor-alpha (TNF-alpha) inhibitor etanercept. Anti-TNF-alpha agents can antagonise the multiple effects of TNF-alpha on the immune system, effects that are required for the continued maintenance of granulomatous structure, and offer a therapeutic strategy in the treatment of IGD associated with arthritis.
Department of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy. angelo.zoli@rm.unicatt.it
Angelo
A
Zoli
Guido
G
Massi
Michela
M
Pinnelli
Chiara Di Blasi
CD
Lo Cuccio
Federica
F
Castri
Gianfranco
G
Ferraccioli
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology; D003875:Drug Eruptions / Q000188:drug therapy / Q000209:etiology; D000068800:Etanercept; D005260:Female; D006099:Granuloma / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept