Kobak Senol
Department of Rheumatology, Istinye University Faculty of Medicine, LIV Hospital, Istanbul, Turkey.
Curr Drug Saf. 2021;16(1):107-109. doi: 10.2174/1574886315999200819153827.
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint and systemic involvement. Tofacitinib is a JAK- inhibitor that is an effective agent in the treatment of active RA. Varicella zoster virus(VZV) reactivation is among the most important adverse effects of tofacitinib. Ramsay-Hunt syndrome(RHS) is a rare clinical condition that develops as a result of VZV reactivation and progresses with hearing loss, dizziness, and facial nerve paralysis.
To present a case of Ramsay-Hunt syndrome due to varicella zoster reactivation in a RA patient using tofacitinib.
A 63-year-old female RA patient under tofacitinib treatment was admitted to the rheumatology outpatient clinic due to widespread skin rashes on her face and ear, and hearing loss. On inspection widespread erythematous, vesicular rashes on the left side of the face, lips, around the eye and in the ear, and mild facial paralysis on the left side were detected. On laboratory investigations, acute phase reactants were increased. Serological study for specific antibodies against varicella zoster virus showed higher titers. Dermatology and ear nose throat specialist consultations were performed, and varicella zoster lesions on the left inner ear, face, and mild facial paresis were considered. According to clinical and laboratory findings, the patient was diagnosed with RHS triggered by tofacitinib. Tofacitinib and methotrexate were discontinued, and intravenous acyclovir was started. On the control examination, the patient's skin lesions and facial nerve paralysis regressed.
Herein, we reported the fırst case of tofacitinib-induced RHS in a patient with RA. This may be another side effect of biologic treatment. New studies are needed on this subject.
类风湿关节炎（RA）是一种以关节和全身受累为特征的慢性炎症性疾病。托法替布是一种JAK抑制剂，是治疗活动性RA的有效药物。水痘带状疱疹病毒（VZV）再激活是托法替布最重要的不良反应之一。拉姆齐-亨特综合征（RHS）是一种罕见的临床病症，由VZV再激活引起，表现为听力丧失、头晕和面神经麻痹。
报告1例使用托法替布的RA患者因水痘带状疱疹再激活导致拉姆齐-亨特综合征的病例。
一名63岁接受托法替布治疗的女性RA患者因面部和耳部广泛皮疹及听力丧失入住风湿病门诊。检查发现面部左侧、嘴唇、眼周和耳部有广泛的红斑、水疱性皮疹，左侧轻度面神经麻痹。实验室检查显示急性期反应物升高。水痘带状疱疹病毒特异性抗体的血清学研究显示滴度较高。进行了皮肤科和耳鼻喉科专家会诊，考虑为左侧内耳、面部的水痘带状疱疹病变及轻度面神经麻痹。根据临床和实验室检查结果，该患者被诊断为由托法替布引发的RHS。停用托法替布和甲氨蝶呤，开始静脉注射阿昔洛韦。在复查时，患者的皮肤病变和面神经麻痹有所缓解。
在此，我们报告了首例RA患者中托法替布诱导的RHS病例。这可能是生物治疗的另一种副作用。对此主题需要进行新的研究。
