title: Cutaneous actinomycosis associated with anti-TNF-alpha therapy: report of two cases.
abstract: Increased susceptibility to infections is among the main safety concerns raised by anti-TNF-α agents. We describe two cases of cutaneous actinomycosis in patients undergoing anti-TNF-α therapy: a 49-year-old female treated with etanercept for rheumatoid arthritis and a 57-year-old female treated with infliximab for psoriasis. Both patients had discharge with the intermittent presence of sulfur granules occurring at the site of previous surgical wounds. Bacteriological culture demonstrated Actinomyces. Since in both cases laboratory findings and medical imaging ruled out visceral actinomycosis, oral antibiotics were introduced without discontinuing anti-TNF-α. The first patient did not relapse after 2 years. The second one did and received a second course of antibiotics combined with transient interruption of the anti-TNF-α therapy. The risk of developing actinomycosis is reported to be similar in immunocompetent and immunocompromised patients, however cases of cutaneous actinomycosis occurring during anti-TNF-α therapy need to be recognized and may be under-reported.
authors.affiliation: Department of Dermatology, Hôpital Edouard Herriot, Lyon, France.
authors.forename: A L
authors.initials: AL
authors.lastname: Breton
authors.forename: G
authors.initials: G
authors.lastname: Lamblin
authors.forename: C
authors.initials: C
authors.lastname: Pariset
authors.forename: D
authors.initials: D
authors.lastname: Jullien
mesh_terms: D000196:Actinomycosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D003879:Dermatologic Agents / Q000009:adverse effects; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects; D000069285:Infliximab; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy; D018124:Receptors, Tumor Necrosis Factor; D012307:Risk Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D003879:Dermatologic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept