Adalimumb Induced Systemic Vasculitis Following Treatment of Hidradenitis Suppurativa

A 52-year-old man, with diabetes mellitus and obesity, hadreceived Adalimumb for extensive Hidradenitis suppurativa.The latter was difficult to control with local antiseptics,antibiotics and surgery. Two weeks later, he developed fever,palpable maculopapular rash and progressive renal failure. Hisskin biopsy showed leucocytoclastic vasculitis with negativeimmune deposits and his kidney biopsy showed crescenticglomerulonephritis. Adalimumb was discontinued and thepatient was treated with Prednisone 1 mg/kg/day. His kidneyfailure improved. However, his skin lesions progressed tonecrotizing fasciitis despite aggressive surgical care.Ultimately, he died from disseminated sepses 2 months later

Rituximab Therapy for Idiopathic Chronic Urticaria with Recurrent Angioedema

We report on 4 patients with severe and idiopathic chronicurticaria with recurrent attacks of angioedema. Initially, theyresponded initially to high dose corticosteroids yet relapsed onhigh-maintenance dose. Subsequently, trial to use steroidsparing drugs viz. intravenous immunoglobulin thenmycophenolate mofetil with hydroxychloroquine and tacrolimushad failed to maintain a remission. Hence, Rituximab wasgiven. One month after Rituximab infusions, Prednisone dosewas successfully tapered down and was discontinued.Subsequently, all patients remained in complete remission for14-24 months of follow up.