Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan.
Department of Pathology, Shimane University Faculty of Medicine, Japan.
Intern Med. 2021 Feb 1;60(3):385-389. doi: 10.2169/internalmedicine.5340-20. Epub 2020 Aug 29.
Anti-tumor necrosis factor (TNF) α agents, widely used for the treatment of Crohn's disease (CD), can sometimes induce skin-associated adverse events, which mainly include psoriasis-like eruptions, eczema, and cutaneous infections. In contrast, purpura caused by vasculitis is rarely seen. We herein report a unique case of leukocytoclastic vasculitis induced by infliximab administered for CD in which intermittent purpura development was noted. Fluorescent immunostaining showed no immunoglobulin A deposition on the vessel walls. No purpura was initially seen after starting infliximab, but it appeared approximately 10 months later; however, administration did not have to be discontinued, and the condition was later resolved. The present findings provide important details regarding vasculitis induced by anti-tumor necrosis factor-α agent administration.
抗肿瘤坏死因子 (TNF) α 制剂广泛用于治疗克罗恩病 (CD),但有时会引起皮肤相关的不良反应,主要包括银屑病样疹、湿疹和皮肤感染。相比之下,由血管炎引起的紫癜则很少见。本文报告了一例使用英夫利昔单抗治疗 CD 时发生白细胞碎裂性血管炎的特殊病例,该患者间歇性出现紫癜。荧光免疫染色显示血管壁无免疫球蛋白 A 沉积。开始使用英夫利昔单抗时并未出现紫癜,但约 10 个月后出现了紫癜;然而,并未因此停止用药,随后病情得到缓解。本研究结果为抗 TNF-α 制剂引起的血管炎提供了重要细节。