Drug-induced Bullous Pemphigoid and Lupus Erythematosus Occurring under Anti-TNF-α and IL-6 Therapy in a Patient with Rheumatoid Arthritis

Noritada Yoshikawa; Erika Matsubara; Motohisa Yamamoto; Hiroki Yamazaki; Masaaki Uehara; Masahiro Kamata; Hirotoshi Tanaka

doi:10.2169/internalmedicine.4646-20

CASE REPORTS

Drug-induced Bullous Pemphigoid and Lupus Erythematosus Occurring under Anti-TNF-α and IL-6 Therapy in a Patient with Rheumatoid Arthritis

Noritada Yoshikawa, Erika Matsubara, Motohisa Yamamoto, Hiroki Yamazaki, Masaaki Uehara, Masahiro Kamata, Hirotoshi Tanaka

Author information

Noritada Yoshikawa
Department of Rheumatology and Allergy, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan
Division of Rheumatology, Center for Antibody and Vaccine Therap, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan
Erika Matsubara
Department of Rheumatology and Allergy, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan
Motohisa Yamamoto
Department of Rheumatology and Allergy, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan
Division of Rheumatology, Center for Antibody and Vaccine Therap, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan
Hiroki Yamazaki
Department of Rheumatology and Allergy, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan
Masaaki Uehara
Department of Rheumatology and Allergy, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan
Masahiro Kamata
Department of Dermatology, Teikyo University School of Medicine, Japan
Hirotoshi Tanaka
Department of Rheumatology and Allergy, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan
Division of Rheumatology, Center for Antibody and Vaccine Therap, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan

Keywords: rheumatoid arthritis, Sjögren's syndrome, bullous pemphigoid, lupus erythematosus, biologics, drug-induced autoimmune reactions

JOURNAL OPEN ACCESS

2020 Volume 59 Issue 20 Pages 2611-2618

DOI https://doi.org/10.2169/internalmedicine.4646-20

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Abstract

A 65-year-old Japanese woman, who was diagnosed with rheumatoid arthritis and Sjögren's syndrome with various autoantibodies including anti-DNA antibody, developed bullous pemphigoid (BP) and hematological abnormalities like lupus erythematosus after adalimumab therapy. The discontinuation of adalimumab resolved those disorders but polyarthritis thereafter relapsed. The introduction of abatacept was not effective, but tocilizumab was found to be effective for polyarthritis, however, thereafter both bullous disease and severe pancytopenia developed. Discontinuation of tocilizumab was effective, but polyarthritis again developed, and baricitinib resolved it. There is an increasing number of reports of drug-induced BP and lupus erythematosus, and biologics might trigger an alteration in the pathophysiological/clinical course of rheumatic disorder.

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