Autoimmune bullous skin diseases occurring under anti-tumor necrosis factor therapy: two case reports.
BACKGROUND
Anti-tumor necrosis factor (TNF) agents are increasingly being used for a rapidly expanding number of rheumatic and systemic diseases. As a result of this use, and of the longer follow-up periods of treatment, there are a growing number of reports of the development of autoimmune processes related to anti-TNF agents. The use of anti-TNF agents has been associated with more and more cases of autoimmune diseases, principally cutaneous vasculitis, lupus-like syndrome, systemic lupus erythematosus and interstitial lung disease.


METHODS
We report 2 cases of autoimmune bullous skin disease occurring in patients undergoing TNF-targeted therapy: a bullous pemphigoid and a pemphigus foliaceus. Both patients were treated by anti-TNF agents for rheumatoid arthritis and showed improvement following interruption of that treatment. Here, we discuss the relationship between anti-TNF therapy and the occurrence of autoimmune bullous disease.


CONCLUSIONS
Anti-TNF agents should be considered as a potential cause of drug-induced autoimmune bullous skin disease.
Boussemart
L
L
Department of Dermatology and Venereology, Hôpital Cochin, Paris, France.
Jacobelli
S
S
Batteux
F
F
Goulvestre
C
C
Grange
P
P
Carlotti
A
A
Morini
J P
JP
Gorin
I
I
Ziza
J M
JM
Avril
M F
MF
Dupin
N
N
D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001323:Autoantibodies / Q000097:blood; D003875:Drug Eruptions / Q000209:etiology; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000139:chemically induced* / Q000175:diagnosis; D010392:Pemphigus / Q000139:chemically induced* / Q000175:diagnosis; D000079424:Tumor Necrosis Factor Inhibitors
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001323:Autoantibodies; D000079424:Tumor Necrosis Factor Inhibitors; D000069285:Infliximab; D000068879:Adalimumab