Borreliosis mimicking lupus-like syndrome during infliximab treatment.
Tumour necrosis factor (TNF)-alpha antagonists are very effective treatments for immune-mediated inflammatory disorders. Adverse events include severe infections and episodes of lupus-like syndrome, multiple sclerosis-like demyelination and other neuropathies. The pathomechanisms of these autoimmune-like syndromes after TNF-alpha blockade are still unknown. We report a patient with psoriasis who developed a lupus-like syndrome during infliximab treatment, which was finally diagnosed as an exaggerated systemic infection with Borrelia burgdorferi. This case suggests that autoimmune-like syndromes may actually represent pre-existing or newly acquired nonseptic bacterial or viral infections, which have escaped immune surveillance during TNF-alpha blockade. Each autoimmune-like syndrome during TNF-alpha blockade should therefore be carefully examined for potential causative infection.
Molin
S
S
Department of Dermatology, Ludwig-Maximilians-University, D-80337 Munich, Germany. sonja.molin@med.uni-muenchen.de
Ruzicka
T
T
Prinz
J C
JC
D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D001899:Borrelia Infections / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D000069285:Infliximab; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced / Q000175:diagnosis*; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy; D017192:Skin Diseases, Bacterial / Q000175:diagnosis*; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab