Rheumatology Department, University Hospital Ramón y Cajal, Ctra. Colmenar Viejo Km. 9,100, 28034 Madrid, Spain.
Clin Rheumatol. 2012 Mar;31(3):563-8. doi: 10.1007/s10067-011-1924-x. Epub 2011 Dec 30.
We report the case of a 72-year-old man with history of ankylosing spondylitis, who, during the treatment with infliximab, developed painful, erythematous-violaceous plaques with later development of ulcers on his feet associated with cold exposure. Concomitantly with the appearance of these lesions, he presented increased antinuclear antibodies (ANA) titers, positivity for anti-DNA and IgM anticardiolipin antibodies, low complement levels, polyclonal hypergammaglobulinemia, and lymphopenia. He was diagnosed of chilblain lupus induced by infliximab, this agent was withdrawn and initiated treatment for chilblains with improvement of lesions. On reviewing of the literature, we found seven reported cases of tumor necrosis factor α (TNF-α) antagonists-induced chilblain lupus, all in rheumatoid arthritis patients and four of them with clinical and immunological characteristics available are presented and compared with our case. Although it is infrequent, chilblain lupus forms part of the spectrum of TNF-α antagonists-induced lupus erythematosus; usually is limited to skin without progression to systemic lupus erythematosus; presents ANA, anti-DNA, and antinucleosome antibodies positivity as more frequent immunological alterations; and responds appropriately to the specific treatment, TNF-α antagonists withdrawal being not necessary in almost all cases.
我们报告了一例 72 岁男性强直性脊柱炎病史患者，在使用英夫利昔单抗治疗期间，脚部出现疼痛、红斑-紫色斑块，随后发展为溃疡，并伴有冷暴露。随着这些病变的出现，他出现了抗核抗体 (ANA) 滴度升高、抗 DNA 和 IgM 抗心磷脂抗体阳性、补体水平降低、多克隆高丙种球蛋白血症和淋巴细胞减少。他被诊断为英夫利昔单抗诱导的寒冷性多形红斑，停用该药物，并开始使用寒冷性多形红斑治疗，病变改善。文献复习发现，7 例 TNF-α 拮抗剂诱导的寒冷性多形红斑，均发生在类风湿关节炎患者中，其中 4 例具有临床和免疫学特征，与我们的病例进行了比较。尽管罕见，但寒冷性多形红斑是 TNF-α 拮抗剂诱导的红斑狼疮的一种表现形式；通常局限于皮肤，不会进展为系统性红斑狼疮；出现 ANA、抗 DNA 和抗核小体抗体阳性等更常见的免疫学改变；并对特定治疗有反应，几乎所有病例都不需要停用 TNF-α 拮抗剂。
