Department of Dermatology, General Hospital of Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France.
Rheumatol Int. 2012 Sep;32(9):2937-40. doi: 10.1007/s00296-011-2016-6. Epub 2011 Jul 29.
Interstitial granulomatous dermatitis belongs to the group of aseptic cutaneous granulomas. It is a histopathological entity encountered in various pathological situations, such as polyarthritis including rheumatoid arthritis, but also systemic lupus erythematosus. It may also occur after systemic administration of medication, thus representing a drug-induced, interstitial granulomatous outbreak. This has recently been described after anti-TNF therapy was taken. We are reporting the case of a patient treated using adalimumab for rheumatoid arthritis and having developed interstitial granulomatous dermatitis during treatment, which revealed lupus erythematosus attributable to the biotherapy. The clinical appearance of interstitial granulomatous dermatitis can vary, and the diagnosis is confirmed by anatomo-pathological examination. Drug-induced interstitial granulomatous outbreaks have specific histological criteria, and secondary cases involving anti-TNF medication have been described. Cases of lupus attributable to anti-TNF therapy have also been described, and they have specific biological characteristics. Like idiopathic lupus, they may be associated with interstitial granulomatous dermatitis, but the association of an anti-TNF-induced lupus and this type of granulomatous has not, to our knowledge, been described before. We are reporting one case, which emphasises the importance of carrying out a complete and systematic aetiological assessment for all cases of interstitial granulomatous dermatitis, including where there is systemic disease or following medical treatment, either of which may provide an evident cause for the granulomatosis. In particular, the outbreak of interstitial granulomatous dermatitis during anti-TNF treatment should lead to screening for a drug-induced lupus, which would require the patient to stop such treatment.
间质性肉芽肿性皮炎属于非感染性皮肤肉芽肿群。这是一种在多种病理情况下都会出现的组织病理学实体，如包括类风湿关节炎在内的多发性关节炎，但也包括系统性红斑狼疮。它也可能在全身用药后发生，因此代表一种药物引起的间质性肉芽肿性发作。最近在接受抗 TNF 治疗后就有这种情况的描述。我们报告了一例接受阿达木单抗治疗类风湿关节炎的患者，在治疗过程中发生了间质性肉芽肿性皮炎，这表明狼疮是由生物疗法引起的。间质性肉芽肿性皮炎的临床表现可能多种多样，诊断通过组织病理学检查确认。药物引起的间质性肉芽肿性发作具有特定的组织学标准，并且已经描述了涉及抗 TNF 药物的继发性病例。抗 TNF 治疗引起的狼疮病例也有描述，它们具有特定的生物学特征。与特发性狼疮一样，它们可能与间质性肉芽肿性皮炎有关，但据我们所知，抗 TNF 诱导的狼疮和这种类型的肉芽肿之间的关联尚未被描述。我们报告了一例病例，强调了对所有间质性肉芽肿性皮炎病例进行全面和系统病因评估的重要性，包括有系统性疾病或在接受治疗后出现的病例，这两者都可能为肉芽肿病提供明显的病因。特别是在接受抗 TNF 治疗期间出现间质性肉芽肿性皮炎时，应进行药物诱导性狼疮的筛查，这需要患者停止此类治疗。
