ABSTRACT
Pityriasis rubra pilaris (PRP) is a chronic papulosquamous disorder of unknown etiology, which may pose therapeutic challenges. There is currently no universally effective treatment for PRP, and some cases are resistant to multiple topical and systemic therapies. Systemic retinoids, methotrexate, several immunosuppressive agents and phototherapy have all been used with varying degrees of success. Recently, a few reports have appeared in the literature, concerning the use of biologics in combination therapies and/or in refractory PRP cases. We report a case of PRP similar to type II with juvenile onset, which was recalcitrant to traditional topical and systemic therapy. He was successfully treated with anti-TNF-alpha monoclonal antibody, infliximab. The patient showed resolution with minimal disease activity, and was maintained on acitretin and emollients. The response to infliximab in our patient and in the previously reported cases confirms a role of anti-TNF-alpha therapy as an effective option in the treatment of PRP.
Subject(s)
Humans , Acitretin , Antibodies, Monoclonal , Emollients , Immunosuppressive Agents , Methotrexate , Phototherapy , Pityriasis , Pityriasis Rubra Pilaris , Retinoids , Skin Diseases, Papulosquamous , InfliximabABSTRACT
El pioderma gangrenoso (PG) es una dermatitis neutrofílica, que en algunos casos puede ser severa y de difícil manejo. Presentamos el caso de una paciente con múltiples lesiones de PG asociadas a colitis ulcerosa, en la cual, por severidad del cuadro, se optó por adicionar infliximab al tratamiento habitual. La respuesta clínica fue excelente y rápida tras la primera dosis de infliximab, pese a que recibió solo dos de las tres dosis recomendadas habitualmente. La mejoría cutánea y digestiva se ha mantenido un año después de este tratamiento. Infliximab ha demostrado ser, en este y otros reportes, una herramienta muy útil, especialmente en casos de compromiso severo como en nuestra paciente. Se requiere mas evidencia aún para comprobar en cuáles pacientes podría ser beneficioso. Se presenta este caso por su severidad y la rápida y sostenida respuesta obtenida con infliximab.
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis and in some cases can be severe and difficult to manage. We report the case of a patient with multiple lesions of PG associated with ulcerative colitis. Due to the severity of the clinical presentation treatment with infliximab was added to standard therapy. Clinical response was excellent and fast after the first dose of infliximab, although ha received only two of the three doses usually recomended. Skin and digestive improvement has been maintained 1 year after treatment. Infliximab has proven, in this and other reports, as a very useful tool in the treatment of PG, especially in cases of severe involvement as in our patient. More evidence is required to prove in which patients with PG infliximab could beneficial. We present this clinical case because of its severity and the rapid and susteined response obtained with infliximab.
Subject(s)
Humans , Adult , Female , Antibodies, Monoclonal/therapeutic use , Colitis, Ulcerative/complications , Pyoderma Gangrenosum/etiology , Pyoderma Gangrenosum/drug therapy , Colitis, Ulcerative/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Treatment OutcomeABSTRACT
Behcet's disease is a chronic disease characterized by recurrent systemic vasculitis. The pathogenesis remains unclear. This disease involves various organs of the body and it can have a variety of symptoms with an unpredictable course. The diagnosis of Behcet's disease is made in patients with oral and genital ulcers and uveitis. In addition, gastrointestinal symptoms are frequently present; however, intestinal ulcers are infrequent. The most common extra-oral sites of gastrointestinal involvement are ileocecal and colon lesions. The lesions are typically resistant to medical treatment and frequently recur after surgical treatment. Here we present two cases treated with the monoclonal antibody anti-tumor necrosis factor (TNF) and regression of all symptoms.
Subject(s)
Humans , Antibodies, Monoclonal , Chronic Disease , Colon , Necrosis , Systemic Vasculitis , Ulcer , Uveitis , InfliximabABSTRACT
OBJECTIVE: To assess the safety of anti-tumor necrosis factor (TNF)-alpha therapy in patients with rheumatic disease and chronic Hepatitis B virus (HBV) infection. METHODS: We used infliximab or etanercept therapy in patients with rheumatic disease and chronic HBV infection. Records concerning these patients were retrospectively reviewed for the duration of disease, treatment, serological status and biological data. RESULTS: Six relevant cases with chronic HBV infection were identified: three of RA; three of AS. Four patients had received etanercept; two had been given etanercept after infliximab. One of the cases treated with lamivudine before anti-TNF-alpha therapy for chronic hepatitis B treatment. His hepatitis status was maintained stable after he initiated anti-TNF-alpha therapy. Five of the cases started anti-TNF-alpha therapy without lamivudine. Two of these five cases were received lamivudine during anti-TNF-alpha therapy due to elevation of HBV DNA titer without liver function test abnormality and then HBV DNA was normalized. Three cases without lamivudine continued to show the stable level of liver enzyme but, one of the three cases showed persistently elevated HBV DNA titer. CONCLUSION: Prophylactic or early intervention strategies with anti-viral agent and regular monitoring of aminotransferases and viral load are needed for patient with evidence of chronic HBV infection.