Department of Dermatology, Hôpital Edouard Herriot, Lyon, France.
Dermatology. 2014;228(2):112-4. doi: 10.1159/000357522. Epub 2014 Feb 22.
Increased susceptibility to infections is among the main safety concerns raised by anti-TNF-α agents. We describe two cases of cutaneous actinomycosis in patients undergoing anti-TNF-α therapy: a 49-year-old female treated with etanercept for rheumatoid arthritis and a 57-year-old female treated with infliximab for psoriasis. Both patients had discharge with the intermittent presence of sulfur granules occurring at the site of previous surgical wounds. Bacteriological culture demonstrated Actinomyces. Since in both cases laboratory findings and medical imaging ruled out visceral actinomycosis, oral antibiotics were introduced without discontinuing anti-TNF-α. The first patient did not relapse after 2 years. The second one did and received a second course of antibiotics combined with transient interruption of the anti-TNF-α therapy. The risk of developing actinomycosis is reported to be similar in immunocompetent and immunocompromised patients, however cases of cutaneous actinomycosis occurring during anti-TNF-α therapy need to be recognized and may be under-reported.
感染易感性增加是抗 TNF-α 药物引起的主要安全问题之一。我们描述了两例接受抗 TNF-α 治疗的患者的皮肤放线菌病病例：一名 49 岁女性因类风湿关节炎接受依那西普治疗，另一名 57 岁女性因银屑病接受英夫利昔单抗治疗。两名患者均在先前手术部位出现带有间歇性硫磺颗粒的分泌物。细菌培养显示放线菌。由于在两种情况下，实验室检查和医学影像学均排除内脏放线菌病，因此在不中断抗 TNF-α 的情况下，采用了口服抗生素。第一例患者在 2 年后未复发。第二例患者复发，并接受了第二疗程的抗生素联合短暂中断抗 TNF-α 治疗。据报道，免疫功能正常和免疫功能低下患者发生放线菌病的风险相似，但是需要认识到在抗 TNF-α 治疗期间发生的皮肤放线菌病，并可能报告不足。
