title: Scabies in a Patient with Rheumatoid Arthritis Treated with Adalimumab - A Case Report.
abstract: Rheumatoid arthritis is a chronic systemic inflammatory disease characterized by synovitis, erosions, and destruction of affected joints. If untreated, it leads to severe disability and premature mortality. Tumor necrosis factor alpha (TNF-α) inhibitors are biological drugs used in treatment of rheumatoid arthritis. Possible side effects include skin allergic reactions, which, if generalized, are the reason for discontinuation of the drug. We report the case of a 46-year-old female patient with rheumatoid arthritis who presented with pruritus and erythematous papular exanthema after administration of the second dose of adalimumab. At first, we suspected a drug hypersensitivity reaction. As the signs and symptoms persisted for 2 months after discontinuation of adalimumab and despite continuous administration of antihistamines and glucocorticoids, further work-up was performed, and scabies was diagnosed. The patient was treated with topical 10% crotamiton. The symptoms were persistent and additional applications of the preparation were needed. After clinical remission of scabies, treatment of active rheumatoid arthritis with adalimumab was restarted without any complications.
authors.forename: Ivan
authors.initials: I
authors.lastname: Marković
authors.forename: Silva
authors.initials: S
authors.lastname: Pukšić
authors.forename: Ana
authors.initials: A
authors.lastname: Gudelj Gračanin
authors.forename: Melanie Ivana
authors.initials: MI
authors.lastname: Čulo
authors.forename: Joško
authors.initials: J
authors.lastname: Mitrović
authors.affiliation: Professor Jadranka Morović-Vergles, MD, PhD, Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, University of Zagreb, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; jmorovic@kbd.hr.
authors.forename: Jadranka
authors.initials: J
authors.lastname: Morović-Vergles
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000287:Administration, Topical; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D010575:Pesticides; D012532:Scabies / Q000175:diagnosis* / Q000188:drug therapy; D014052:Toluidines / Q000008:administration & dosage*
chemical_list: D018501:Antirheumatic Agents; D010575:Pesticides; D014052:Toluidines; C005553:crotamiton; D000068879:Adalimumab