[Active WHO class IV lupus nephritis in a patient treated with etanercept for a psoriasic arthritis].
BACKGROUND
Drug-induced lupus nephritis in patients treated with TNF α inhibitor is a rare adverse effect. Anti-TNF α therapies are commonly associated with the induction of auto-antibodies, whereas anti-TNF α-induced lupus is rare, most frequently involving arthritis and cutaneous lesions. However, several renal involvement has been reported.


METHODS
A 26-year old woman with a history of psoriasic arthritis treated with TNF α inhibitor (etanercept) presented with a biopsy-proved class IV lupus nephritis. The diagnosis of drug-induced lupus nephritis was probable and anti-TNF α therapy was discontinued. Standard lupus nephritis therapy was then started with prednisolone pulses and mycophenolate mofetil (MMF). Two weeks later, a septic shock following a leg cellulitis was caused by Pseudomonas aeruginosa and had a fatal evolution despite MMF withdrawal, adapted antibiotherapy and large wound excision.


CONCLUSIONS
Our therapy was not different than for other class IV lupus nephritis. Our observation highlights two points: first the attributability to etanercept in lupic manifestations in our patient and second the therapeutic strategy in this particular case of drug-induced lupus.


CONCLUSIONS
We reported a possible first case of IV lupus nephritis induced by anti-TNF α with a fatal evolution.
Sacquépée
Mathieu
M
Association pour le traitement de l'insuffisance rénale en Nouvelle-Calédonie, 193, rue Benebig, 98800 Nouméa, Nouvelle-Calédonie. msacquepee@atir.asso.nc
Rouleau
Vincent
V
Cantin
Jean-François
JF
Quirin
Nicolas
N
Doussy
Yves
Y
Valéry
Jean-Claude
JC
Picu
Cristina
C
Tivollier
Jean-Michel
JM
D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D002481:Cellulitis / Q000382:microbiology; D000068800:Etanercept; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000009:adverse effects*; D008181:Lupus Nephritis / Q000139:chemically induced* / Q000145:classification; D011552:Pseudomonas Infections / Q000150:complications; D011550:Pseudomonas aeruginosa; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage; D012772:Shock, Septic / Q000382:microbiology
D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept