Two case reports of Mycobacterium marinum infection with psoriatic arthritis treated by tumor necrosis factor‐α inhibitors
Two case reports of Mycobacterium marinum infection with psoriatic arthritis treated by tumor necrosis factor‐α inhibitors
复制标题
肿瘤坏死因子-α抑制剂治疗海分枝杆菌感染并发银屑病关节炎2例报告
DOI：
10.1111/1346-8138.15674
复制
发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Umegaki‐Arao Noriko
中科院分区：
文献类型：
--
作者：
Furuichi Yuki;Ito Yoshihiro;Tanese Keiji;Mukai Miho;Uwamino Yoshifumi;Hasegawa Naoki;Amagai Masayuki;Umegaki‐Arao Noriko
病例1报告一名患有银屑病关节炎（PsA）的49岁男性患者，接受英夫利昔单抗治疗3年。IFX治疗未见皮疹或关节疼痛，但右手第三指背表面出现硬化红斑，随后出现疼痛的皮下神经结节，沿右臂淋巴血管扩散。诊断为皮肤NTM时给予莫西沙星、强力霉素、磺胺甲恶唑甲氧苄啶。PsA和m。经IFX和4个月疗程的抗生素治疗，感染得到良好控制。病例2为58岁男性PsA患者，曾放养热带鱼，右手第三指背表面出现糜烂性红斑，右臂淋巴血管周围出现皮下结节。由阿达木单抗和甲氨蝶呤组成的PsA治疗立即停止。皮肤组织培养和MALDI生物分型诊断为m。marinuminfection。因PsA复发给予Brodalumab治疗，抗菌药物（克拉霉素、乙胺丁醇、多西环素）治疗5个月治愈NTM感染。在大多数病例中，生物制剂已停止使用。用TNF-a抑制剂治疗牛皮癣的海上感染，因为TNF-a在肉芽肿形成过程中对限制感染的传播至关重要。然而，我们成功地管理了PsA和m。再次使用生物制剂和联合使用抗生素治疗海洋感染。在难治性银屑病病例中，应仔细评估重新使用生物制剂的风险和益处。总之，对患者进行深入的访谈和生物制剂的生活方式指导似乎是预防和控制m的必要条件。marinuminfections。
Case 1 report a 49-year-old man with psoriatic arthritis (PsA) who had been receiving infliximab for 3 years. While no eruption or joint pain was observed under IFX treatment, indurated erythema appeared on the dorsal surface of the third digit of the right hand, followed by painful subcuta neous nodules that spread along the lymphatic vessels on the right arm. Under the diagnosis of cutaneous NTM, moxifloxacin, doxycycline and sulfamethoxazole trimethoprim were administrated. Both PsA andM. marinuminfection were well-controlled by the IFX and 4-month course of antibiotics, respectively. Case 2 was a 58-year-old man with PsA, who had been caring for tropical fish, and developed an erosive erythema on the dorsal surface of the third digit of the right hand and subcutaneous nodules along the lymphatic vessels of the right arm. Treatment for PsA consisting of adalimumab and methotrexate was discontinued immediately. Skin tissue culture and MALDI Biotyper led to a diagnosis ofM. marinuminfection. Brodalumab was administrated because of PsA recurrence, and antibacterial treatment (clarithromycin, ethambutol and doxycycline) for 5 months cured the NTM infection. Biologics are discontinued in most cases ofM. marinuminfection with psoriasis treated by TNF-a inhibitors because TNF-a is essential during granuloma formation to limit the spread of infection. However, we successfully managed PsA andM. marinuminfection with re-administration of biologics and a combination of antibiotics, respectively. The risks and benefits of restarting biologics should be carefully evaluated in intractable psoriatic cases. In conclusion, an in-depth interview and lifestyle guidance for patients on biologics seem necessary to prevent and controlM. marinuminfections.