Etanercept-induced erythema nodosum in a patient with rheumatoid arthritis: Case report and literature review
Etanercept-induced erythema nodosum in a patient with rheumatoid arthritis: Case report and literature review
复制标题
类风湿性关节炎患者依那西普诱发结节性红斑：病例报告及文献复习
DOI：
10.1111/1346-8138.16636
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Fujimoto M.
中科院分区：
文献类型：
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作者：
Kurokami Y;Ueda-Hayakawa I;Fujimoto M.
依那西普是一种重组的可溶性肿瘤坏死因子α(α)受体，用于治疗炎症性疾病。在此，我们报告一位类风湿性关节炎(RA)患者因输注依那西普治疗类风湿性关节炎(RA)而出现结节性红斑(EN)的病例。这位76岁的女性主诉发热超过38摄氏度，并在发病前一天出现皮肤损害。她有类风湿性关节炎病史，在发病前20天开始接受依那西普治疗，最近一次输液是在发病前4天。依那西普改善了她的关节疼痛。体检发现她的四肢和躯干上有明显的痛性红斑(图1a)。血液检查显示白细胞计数正常，C反应蛋白升高(13.91 mg/dL)，血小板下降(8.3万/μL)。其他实验室检查，包括抗核抗体和抗中性粒细胞胞浆抗体，都是正常的。对她的右小腿病变进行了皮肤活检。组织病理学检查显示，间隔性脂膜炎伴有中性粒细胞、淋巴细胞和核尘的浸润，而Miescher‘s放射状肉芽肿则不存在(图1b，c)。由于病理未见小叶性脂膜炎、脂肪萎缩或脂肪吞噬，韦伯-克里斯蒂安病被排除在外。进行组织培养，结果为阴性。这些发现与EN是一致的。
Etanercept is a recombinant soluble tumor necrosis factor α (TNF-α) receptor used to treat inflammatory disorders. Here, we report a case of a patients with rheumatoid arthritis (RA) who developed erythema nodosum (EN) caused by etanercept infusion for RA management.A 76-year-old woman complained of fever over 38 C and skin lesions from the day before presentation. She had a history of RA and started therapy with etanercept infusion 20 days before presentation, and her most recent infusion was 4 days before her presentation. Her joint pain improved with etanercept. Physical examination revealed palpable painful erythema on her extremities and trunk (Figure 1a). Blood tests showed normal white blood cell count, elevated C-reactive protein (13.91 mg/dL), and decreased platelets (83 000 per μL). Additional laboratory tests, including antinuclear antibody and antineutrophil cytoplasmic antibody, were normal. A skin biopsy was performed for her right lower leg lesion. Histopathology demonstrated septal panniculitis with infiltration of neutrophils, lymphocytes, and nuclear dust, while Miescher's radial granuloma was absent (Figure 1b, c). Because the pathology did not show lobular panniculitis or lipoatrophy or lipophagia, Weber-Christian disease was excluded. Tissue culture was performed and the results were negative. These findings were consistent with EN.