Orogenital ulcers and the Behcet’s disease

Behcet’s’s disease is a systemic vasculitis involving small to large veins and arteries. It is a sporadic disease, mostly prevalent among the ancestors of the silk route. It is characterized by recurrent oral ulcers, genital ulcers, and uveitis. It also can manifest as skin, vascular, gastrointestinal, neurological, cardiac, and renal involvement. Though overall mortality is around 5%, delay in diagnosis and treatment may lead to significant morbidity. Cardiovascular and pulmonary arterial aneurysms are dreadful complications of this disease. Being uncommon in south India it is liable to be wrongly diagnosed and treated. Delay in the diagnosis and treatment may lead to severe complications. Here we present a case of Behcet’s disease which was managed at primary health care inadequately. We also demonstrated a quick response to steroids which are the mainstay of treatment. In this case presentation we illustrated pre and post treatment scrotal and oral Behcet’s’s lesions for clinicians to memorize. We also discussed international criteria to diagnose Behcet’s disease (ICBD) in concurrence with our case. In this presentation, we briefly described the involvement of other systems and their treatment. This article also elaborated on the latest developments in the treatment of Behcet’s disease.

A Case of Psoriasiform Dermatitis Followed by Tumor Necrosis Factor Inhibitor Treated with Phototherapy

Although tumor necrosis factor (TNF)-alpha antagonist is a successful treatment modality for various autoimmune diseases, including rheumatoid arthritis (RA), ankylosing spondylitis and psoriatic arthritis, many adverse effects have been reported. Cutaneous adverse reactions of TNF-alpha antagonist include skin rash, urticaria, lupus like rash, seborrheic dermatitis and different kinds of psoriasiform dermatitis. We report a case of psoriasiform dermatitis during TNF-alpha antagonist treatment in a 50-year-old woman with RA. The patient has been treated with adalimumab. After 2 months, she developed pruritic erythematous eruption and desquamative lesions on the head and limbs, which were defined as psoriasiform change by a skin biopsy. These skin lesions are successfully treated with combination therapy, including cessation of adalimumab, corticosteroid and phototherapy.

Multifocal Motor Neuropathy with Conduction Blocks During TNF-alpha Antagonist Therapy in a Patient with Spondyloarthropathy

Tumor necrosis factor (TNF)-alpha antagonist has been proven to have benefit for rheumatologic diseases. Because TNF-alpha is not only an important mediator of inflammation in human body, but plays many physiologic roles, it can cause unique adverse effects or complications related to these functions. Adverse effects involving neurological systems, such as Guillain-Barre syndrome, Chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy with conduction blocks (MMNCB), distal symmetric polyneuropathy, and small fibers neuropathy have been previously reported. However, only several cases of infliximab-associated MMNCB are reported. We report a case of MMNCB which developed while treating spondyloarthropathy with infliximab.

A Case of Development of Vitiligo Followed by TNF-alpha Antagonist Treatment for Rheumatoid Arthritis

As the usage of biologics for rheumatic diseases increases, such as rheumatoid arthritis and ankylosing spondylitis, various cutaneous adverse events are also being increasingly reported. We experienced a case of development of vitiligo during a TNF-alpha antagonist therapy in a 22-year-old woman with rheumatoid arthritis. The patient was presented with vitiligo lesions on the dorsum of both hands after 1 month of treatment with etanercept. Vitiligo improved with topical tacrolimus ointment and excimer laser treatment without the discontinuation of etanercept. No clearly defined mechanism for vitiligo induced by TNF-alpha antagonist exits. However, considering that vitiligo is an autoimmune disorder, the development of this skin lesion in association with the TNF-alpha antagonist could be explained by a paradoxical induction of the autoimmune process.

New Therapeutic Modalities for Asthma: Biologicals from a Practical Point of View / 대한내과학회지

Asthma is a representative allergic disease of chronic airway inflammation. Dyspnea, wheezing, cough, and chest tightness are typical symptoms. Treatment consists of inhaled corticosteroid, beta2 agonist, leukotriene modifiers, and xanthines such as theophylline. Clinical practice guidelines for asthma have been developed since early 1990s. However, there are still many uncontrolled asthma patients with severe refractory symptoms, frequent exacerbations and even mortality. These patients cause high socioeconomic burden but the management of these patients are not well covered by clinical practice guidelines. High-dose steroid, methotrexate, cyclosporine, gold, IVIG, and macrolides have been suggested as therapeutic modalities for refractory asthma but with limited treatment effect and side effects. It is necessary to develop new therapeutic modalities for asthma. Biologicals, or biologics, are a variety of protein-based therapeutics, e.g. antibodies, soluble receptors, recombinant protein-based receptor antagonists and other related structures. New biologicals for the treatment of asthma are being developed. Here I will focus on three biologicals from a practical point of view: a humanized monoclonal anti-IgE antibody (omalizumab), anti-IL5, and TNF-alpha antagonist.

Effect of Inhibitor of TNF-alpha on Lipopolysaccharide-induced Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tumor necrosis factor (TNF)-alpha, a potent inflammatory mediator, seems to be important in the pathogenesis of otitis media with effusion (OME). The purpose of this study is to determine the effect of TNF-alpha antagonist on the outcome of experimental OME induced by lipopolysaccharide (LPS) in rats. MATERIALS AND METHODS: Otitis media was induced by injecting 40 microliter (1 mg/ml) of Pseudomonas aeruginosa LPS transtympanically in one group of rats. Other groups were treated with LPS after transtympanic injection of TNF-alphaantagonist, soluble TNF receptor type I (sTNF RI), 10 microliter (0.1 microgram/ microliter), and with saline as controls. Twelve hours after inoculation of LPS, otoscopic examination and aspiration of middle ear effusion (MEE) were done. The temporal bones in each group were harvested and examined histopathologically and vascular permeability (VP) of middle ear (ME) mucosa was measured by Evans blue vital dye technique. RESULTS: The percentage of MEE developing in the LPS and LPS with sTNF RI (combination) groups were 90% and 0%, respectively. Histopathologic examination of ME revealed less inflammation and mucosal thickening, and a significant decrease in the middle ear VP in the combination group when compared with the LPS group. CONCLUSION: Transtympanic administration of TNF-alphaantagonist appears to suppress the development of LPS-induced OME. This study suggests that TNF-alpha antagonist along with antibiotics may have an adjunctive role in the future treatment of MEE.