Di Costanzo Luisa, Ayala Fabio, Megna Matteo, Gaudiello Francesca, Patrì Angela, Balato Nicola
Department of Dermatology - University of Naples Federico II, Naples, Italy.
J Dermatol Case Rep. 2013 Mar 30;7(1):1-4. doi: 10.3315/jdcr.2013.1126.
Tumor necrosis factor-α (TNF-α) inhibitors represent efficacious therapeutic agents in many chronic inflammatory diseases such as psoriasis and rheumatoid arthritis. However they have been connected with increased risk of infection and reactivation of a variety of infectious agents, such as viruses. The reactivation of varicella zoster virus infection causes herpes zoster (HZ), a self-limiting, dermatomally localized, vesicular rash that can be accompanied by postherpetic neuralgia and severe neurological complications.
Limited information has been published regarding HZ during therapy with TNF-α inhibitors especially for the occurrence of HZ during adalimumab treatment. We report the case of a 58-year-old immunocompetent man with a 18-year history of plaque psoriasis who develops ophthalmic HZ during treatment with adalimumab.
We report this case to enrich the literature and to highlight the increased risk of HZ infections in patient on anti-TNF-α therapy (incidence of HZ is about 3-fold increased respect to general population). Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. Therefore, it is very important to identify early signs and symptoms of herpes zoster in patients on biologic therapy in order to start prompt efficient antiviral treatment to prevent the development of severe complications.
肿瘤坏死因子-α（TNF-α）抑制剂在许多慢性炎症性疾病如银屑病和类风湿关节炎中是有效的治疗药物。然而，它们与感染风险增加以及多种感染因子（如病毒）的重新激活有关。水痘带状疱疹病毒感染的重新激活会导致带状疱疹（HZ），这是一种自限性的、沿皮节分布的水疱性皮疹，可伴有带状疱疹后神经痛和严重的神经并发症。
关于TNF-α抑制剂治疗期间的HZ，尤其是阿达木单抗治疗期间HZ的发生，已发表的信息有限。我们报告了一例58岁免疫功能正常的男性病例，该患者有18年斑块状银屑病病史，在接受阿达木单抗治疗期间发生了眼部HZ。
我们报告此病例以丰富文献，并强调抗TNF-α治疗患者中HZ感染风险增加（HZ发病率相对于普通人群增加约3倍）。临床上，这些感染往往有非典型表现，可能妨碍及时诊断。因此，识别生物治疗患者中带状疱疹的早期体征和症状非常重要，以便开始及时有效的抗病毒治疗，预防严重并发症的发生。
