title: Amicrobial pustulosis-like rash in a patient with Crohn's disease under anti-TNF-alpha blocker.
abstract: Amicrobial pustulosis of the folds (APF) is a recently described entity characterized by relapsing pustular lesions predominantly involving the cutaneous flexures and scalp. This disease typically occurs in association with systemic lupus erythematosus and a variety of other autoimmune diseases. We here describe an APF-like pustular eruption predominantly affecting the scalp, face and trunk, occurring during long-term infliximab treatment for Crohn's disease. Immunohistochemical staining of skin biopsy specimens for myxovirus resistance protein A, a marker for type 1 interferon-inducible proteins, showed increased staining in the epidermis and dermal mononuclear inflammatory infiltrate. Our observation further extends the spectrum of cutaneous adverse reactions potentially related to anti-tumor necrosis factor-α, the clinical context in which APF can occur as well as its clinical presentations.
authors.affiliation: Department of Dermatology, Inselspital, University Hospital of Berne, Berne, Switzerland.
authors.forename: Haur Yueh
authors.initials: HY
authors.lastname: Lee
authors.forename: Nedzmidin
authors.initials: N
authors.lastname: Pelivani
authors.forename: Helmut
authors.initials: H
authors.lastname: Beltraminelli
authors.forename: Ivan
authors.initials: I
authors.lastname: Hegyi
authors.forename: Nikhil
authors.initials: N
authors.lastname: Yawalkar
authors.forename: Luca
authors.initials: L
authors.lastname: Borradori
mesh_terms: D056150:Acute Generalized Exanthematous Pustulosis / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000627:therapeutic use; D005260:Female; D019204:GTP-Binding Proteins / Q000378:metabolism; D005765:Gastrointestinal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab; D064547:Myxovirus Resistance Proteins; D009504:Neutrophils / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D005765:Gastrointestinal Agents; D064547:Myxovirus Resistance Proteins; D014409:Tumor Necrosis Factor-alpha; D019980:Amoxicillin-Potassium Clavulanate Combination; D011239:Prednisolone; D000069285:Infliximab; D019204:GTP-Binding Proteins