Double Infection in a Patient with Psoriatic Arthritis Under TNF-alpha Blockers Therapy: A Case Report / Benedetto Caroleo, Alberto Migliore, Erika Cione, Stefania Zampogna, Francesco Perticone, Giovambattista De Sarro, Luca Gallelli

Background: Either direct or indirect tumor necrosis factor (TNF)-alpha blockers are usually used to treat psoriatic arthritis (PA), but their use can increase susceptibility to infectious diseases. Case Presentation: We report a rare case of double skin-knee wound and lung non-tubercular infection in a patient with PA under TNF-alpha blockers therapy. About 1 year after the beginning of adalimumab, a 48-year-old smoker suffering of PA was hospitalized for the skin-knee wound. Results: Clinical evaluation and biochemical markers excluded the presence of a systemic disease, and a skin infection sustained by leishmaniasis probably related to adalimumab was diagnosed (Naranjo score: 6). Adalimumab was discontinued and oral treatment with apremilast and topical treatment with meglumine antimoniate was started with a complete remission of skin wound in 2 weeks. About 7 months later when the patient was under apremilast treatment, he presented to our observation for dyspnea, cough and fever. High-Resolution Computer Tomography (HRCT) chest highlighted alveolar involvement with centrilobular small nodules, branching linear and nodular opacities. Microbiological culture of both broncho-alveolar lavage fluid and sputum documented an infection sustained by nontuberculous mycobacteria. Even if apremilast treatment probably-induced lung infection, we can’t exclude that it worsened a clinical condition induced by adalimumab. Apremilast was stopped and an empirical antitubercular treatment was started. Patient's breathlessness and cough improved as confirmed also by HRCT chest. Conclusion: This case highlights the importance to consider the possibility to develop leishmaniasis and/or non-tubercular mycobacterial infection in patients treated with TNF-alpha inhibitors.

Medienart:	E-Artikel

Erscheinungsjahr:	2019
Erschienen:	2019

Enthalten in:	Zur Gesamtaufnahme - volume:14
Enthalten in:	Current drug safety - 14(2019), 2, Seite 147-

Sprache:	Englisch

Beteiligte Personen:	Caroleo, Benedetto [VerfasserIn] Migliore, Alberto [VerfasserIn] Cione, Erika [VerfasserIn] Zampogna, Stefania [VerfasserIn] Perticone, Francesco [VerfasserIn] Sarro, Giovambattista De [VerfasserIn] Gallelli, Luca [VerfasserIn]

Links:	FID Access [lizenzpflichtig]

Umfang:	1 Online-Ressource (4 p)

Förderinstitution / Projekttitel:

PPN (Katalog-ID):	KFL009016732