title: Dermatomyositis induced by anti-tumor necrosis factor in a patient with juvenile idiopathic arthritis.
abstract: OBJECTIVE
  Biologic therapies, including anti-tumor necrosis factor (TNF) agents, are increasingly used to treat a variety of autoimmune diseases. Paradoxically, these agents have been reported to induce some of the very diseases they were designed to treat, including dermatomyositis (DM). We describe the first case of anti-TNF-associated DM without muscle involvement presenting in an adult patient with a history of arthritis since childhood. This cutaneous eruption recurred after rechallenge with an alternate anti-TNF agent.
  
  
  METHODS
  A 46-year-old man with juvenile idiopathic arthritis developed a pruritic cutaneous eruption while receiving etanercept. Given concern about a drug-induced eruption, etanercept therapy was discontinued and the cutaneous findings improved. However, after rechallenge with adalimumab, he developed similar findings consistent with the skin manifestations of DM. After discontinuation of all anti-TNF drug therapy and the addition of methotrexate sodium, his eruption improved.
  
  
  CONCLUSIONS
  Because the use of these agents is increasing, practitioners should be aware of the possibility of anti-TNF-induced autoimmune disorders, including DM. The case described herein is unique in that anti-TNF-induced autoimmune disease occurred in a patient with existing arthritis since childhood and recurred with rechallenge, adding further evidence to support the existence of anti-TNF-induced DM.
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Stephanie W
authors.initials: SW
authors.lastname: Liu
authors.forename: Nicole F
authors.initials: NF
authors.lastname: Velez
authors.forename: Christina
authors.initials: C
authors.lastname: Lam
authors.forename: Alisa
authors.initials: A
authors.lastname: Femia
authors.forename: Scott R
authors.initials: SR
authors.lastname: Granter
authors.forename: Henry B
authors.initials: HB
authors.lastname: Townsend
authors.forename: Ruth Ann
authors.initials: RA
authors.lastname: Vleugels
mesh_terms: D000068879:Adalimumab; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D003882:Dermatomyositis / Q000139:chemically induced* / Q000503:physiopathology; D003875:Drug Eruptions / Q000209:etiology / Q000503:physiopathology; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate