title: Paradoxical mucocutaneous flare in a case of Behçet's disease treated with tocilizumab.
abstract: We report on a patient with a long-standing history of recurrent oral aphthosis and pseudofolliculitis, diagnosed with Behçet's disease (BD), previously treated with high-dose prednisone, colchicine, cyclosporine, cyclophosphamide and methotrexate, all of which were partially effective. Treatment with the chimeric mouse-human anti-tumour necrosis factor (TNF)-α monoclonal antibody infliximab brought about the resolution of mucocutaneous lesions for a period of 6 years. After an oral and articular BD relapse, the anti-interleukin-6 agent tocilizumab was started in association with high-dose prednisone. Unexpectedly, the patient experienced a paradoxical mucocutaneous flare following tocilizumab administration, which worsened after the second infusion. Tocilizumab was then discontinued, and total recovery was achieved after the patient was started on the fully human anti-TNF-α monoclonal antibody golimumab in association with colchicine and methylprednisolone.
authors.affiliation: Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Siena, Italy, cantariniluca@hotmail.com.
authors.forename: Luca
authors.initials: L
authors.lastname: Cantarini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lopalco
authors.forename: Antonio
authors.initials: A
authors.lastname: Vitale
authors.forename: Laura
authors.initials: L
authors.lastname: Coladonato
authors.forename: Donato
authors.initials: D
authors.lastname: Rigante
authors.forename: Orso Maria
authors.initials: OM
authors.lastname: Lucherini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lapadula
authors.forename: Florenzo
authors.initials: F
authors.lastname: Iannone
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001528:Behcet Syndrome / Q000188:drug therapy*; D018450:Disease Progression; D003875:Drug Eruptions / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D012008:Recurrence; D013281:Stomatitis, Aphthous / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D005938:Glucocorticoids; C529000:golimumab; C502936:tocilizumab; D008775:Methylprednisolone
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