title: Stevens-Johnson syndrome complicating adalimumab therapy in rheumatoid arthritis disease.
abstract: The efficacy of adalimumab, a fully human anti-tumor necrosis factor-α recombinant antibody, has dramatically improved the quality of life of patients with rheumatoid and psoriatic arthritis and Crohn's disease. Because it is fully human, one should not expect immune reactions to this molecule. Adverse reactions to adalimumab are limited mainly to injection site reactions and are very common. We, however, report a case of Stevens-Johnson syndrome that required hospitalization and cessation of adalimumab in a patient with rheumatoid arthritis (RA). In this case report, a 53-year-old woman with RA developed severe mucositis, peripheral rash and desquamation and fever concomitant with the fifth dose of 40 mg adalimumab. Infective etiologies were excluded. The patient responded rapidly to IV hydrocortisone and was able to be commenced on infliximab without recurrence of the Stevens-Johnson syndrome. Severe skin reactions induced by TNF-α antagonists can be very serious, and prescribers need to be aware of the potential for the mucocutaneous adverse effects from the use of these agents, particularly due to the significant morbidity and mortality that are associated with SJS.
authors.affiliation: Rheumatology and Physical Rehabilitation Department, Military Hospital Mohammed V, PO Box: 1018, Rabat, Morocco. azizamounach@yahoo.fr
authors.forename: Aziza
authors.initials: A
authors.lastname: Mounach
authors.forename: Asmae
authors.initials: A
authors.lastname: Rezqi
authors.forename: Abderrazak
authors.initials: A
authors.lastname: Nouijai
authors.forename: Imad
authors.initials: I
authors.lastname: Ghozlani
authors.forename: Lahsen
authors.initials: L
authors.lastname: Achemlal
authors.forename: Abdellah El
authors.initials: AE
authors.lastname: Maghraoui
authors.forename: Ahmed
authors.initials: A
authors.lastname: Bezza
mesh_terms: D000068879:Adalimumab; D061605:Administration, Intravenous; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D057915:Drug Substitution; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D000069285:Infliximab; D008875:Middle Aged; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000069285:Infliximab; D000068879:Adalimumab; D006854:Hydrocortisone