Geller Lauren, Kellen Roselyn
Departments of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York. Lauren.
Dermatol Online J. 2017 Feb 15;23(2):13030/qt87k9b0x2.
Tumor necrosis factor (TNF) antagonists have beenknown to trigger new-onset psoriasis in adult andpediatric patients. Here we report a case of TNFantagonist-induced psoriasis in a 3-year-old boytreated with infliximab for Kawasaki disease. Ourpatient is a 3-year-old boy with Kawasaki diseaseunresponsive to intravenous immunoglobulinwho was then treated with one dose of infliximab.A few days later he developed psoriatic plaqueson the face and extremities. The psoriatic plaqueswere treated with topical calcineurin inhibitors andtopical corticosteroids, with marked improvement.Prior reports of TNF antagonist-induced psoriasis inthe pediatric population have been in children withinflammatory bowel disease or juvenile idiopathicarthritis. To the best of our knowledge, this is thefirst case of TNF antagonist-induced psoriasis ina pediatric patient with Kawasaki disease, andthe youngest patient to date. Although we donot fully understand the mechanism behind thisphenomenon, in vitro studies have implicated theimportance of interferon-α, a pro-inflammatorycytokine, and plasmacytoid dendritic cells. Furtherresearch is necessary to understand who is at riskfor this condition and the molecular basis for thisparadoxical reaction.
已知肿瘤坏死因子（TNF）拮抗剂会在成人和儿童患者中引发新发银屑病。在此，我们报告一例3岁男孩因川崎病接受英夫利昔单抗治疗后发生TNF拮抗剂诱导的银屑病病例。我们的患者是一名3岁患有川崎病的男孩，对静脉注射免疫球蛋白无反应，随后接受了一剂英夫利昔单抗治疗。几天后，他在面部和四肢出现了银屑病斑块。这些银屑病斑块采用外用钙调神经磷酸酶抑制剂和外用糖皮质激素治疗，有明显改善。此前关于儿科人群中TNF拮抗剂诱导银屑病的报道均为患有炎症性肠病或幼年特发性关节炎的儿童。据我们所知，这是首例在患有川崎病的儿科患者中发生TNF拮抗剂诱导的银屑病病例，也是迄今为止最年幼的患者。尽管我们尚未完全理解这一现象背后的机制，但体外研究表明促炎细胞因子α干扰素和浆细胞样树突状细胞的重要性。有必要进一步研究以了解哪些人有患这种疾病的风险以及这种矛盾反应的分子基础。
