Clinical Image

Granuloma Annulare, Drug-Induced Lupus and Certolizumab-Pegol Therapy

Popp F1*, Fischer S2, Kempf W3, Kempis J1, Welcker M4 and Mueller RB1
1Department of Rheumatology, Kantonsspital St. Gallen, Switzerland
2Department of Anesthesiology, Spital Schwyz, Switzerland
3Kempf und Pfaltz, Histologische Diagnostik AG, Zürich, Switzerland
4MVZ für Rheumatologie, Planegg, Germany

*Corresponding author: Florian Popp, Department of Rheumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland


Published: 14 Apr, 2017
Cite this article as: Popp F, Fischer S, Kempf W, Kempis J, Welcker M, Mueller RB. Granuloma Annulare, Drug-Induced Lupus and Certolizumab-Pegol therapy. Ann Clin Case Rep. 2017; 2: 1338.

Clinical Image

A 28-year-old female patient with Crohn’s disease presented with progressive arthralgia, morning stiffness and a rash on her upper limbs. Symptoms developed insidiously during certolizumab-pegol (CZP) therapy. In parallel an increase of ANA developed (homogeneous, 1:320). ENA-screening, including histone antibodies, was negative. Histopathologically a granuloma annulare (GA) was diagnosed and in summary, diagnosis of a drug-induced lupus (DIL) was clinically established. Treatment cessation with CZP resulted in regression of these symptoms (Figure 1-3).
DIL is a typical adverse event of TNF-antagonists [1,2]. Appearance of GA as a symptom during TNF-antagonists therapy is rare and only in case reports documented [3-5]. No case of GA was described to our knowledge neither secondary to CZP therapy nor in association with DIL.
Occurrence of GA during TNF-antagonists therapy should be considered for new unclear skin manifestations. A routine clinical examination including ANA-titer measurement is recommended during TNF-antagonists therapy.

Figure 1

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Figure 1
Granuloma annulare upper limb right.

Figure 2

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Figure 2
Interstitial infiltrate in the upper and mid dermis (H and E, Original magnification ×2).

Figure 3

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Figure 3
Interstitial component with mainly histiocystes, perivascular component with mainly lymphocytes (H and E, Original magnification ×200).

References

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