Varicella zoster virus infection in patients taking the TNF-alpha inhibitor, etanercept: coincidence or causal?
Ninety percent of varicella infections are seen in children under the age of ten and usually follow a benign clinical course with complete resolution of symptoms in one to three weeks. Herpes zoster an acute vesicular eruption due to the varicella-zoster virus (VZV), occurs mostly in adults. Biologic agents include tumor necrosis factor alpha (TNF-alpha) inhibitors that have significantly impacted the treatment of autoimmune and inflammatory conditions. Therapy with TNF-alpha inhibitors poses a potential risk of serious infections secondary to their immunomodulating properties; however multiple studies have demonstrated acceptable safety and tolerability profiles. A case of documented VZV infection (varicella) in an adult receiving the TNF-alpha inhibitor etanercept is described here.
Izumi
Allan
A
Department of Dermatology, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA.
D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D002644:Chickenpox / Q000150:complications / Q000188:drug therapy*; D000068800:Etanercept; D006254:Hawaii; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D007121:Immunocompetence; D007074:Immunoglobulin G / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy; D018124:Receptors, Tumor Necrosis Factor; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000998:Antiviral Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept; D000212:Acyclovir