Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e1046-e1050. doi: 10.1097/MEG.0000000000002170.
The introduction of TNF blockers in the therapeutic armamentarium of inflammatory bowel diseases (IBD) has largely advanced the way by which clinicians manage these disorders. However, some patients develop de novo immune-mediated diseases during the treatment. We here present the case of paradoxical hidradenitis suppurativa, a chronic inflammatory skin disease characterized by the development of recurrent nodules and abscesses in intertriginous areas, in a 20-year-old, nonsmoker, normal-weight women, with no family history of hidradenitis suppurativa or IBD, diagnosed with nonstricturing nonpenetrating ileocolonic Crohn's disease in 2013, during treatment with infliximab. Infliximab discontinuation was followed by a significant improvement of skin lesions. We also discuss 22 additional cases of paradoxical hidradenitis suppurativa in IBD patients on TNF antagonists reported in the literature with the aim to identify potential risk factors for the development of such a complication. All the patients had Crohn's disease, and the majority of them were women (19/23; 82.6%). All cases occurred during therapy with anti-TNF agents [14/23 (61%) patients were treated with adalimumab and 9/23 (39%) patients were treated with infliximab]. The therapeutic approach directed at maintaining/holding the undergoing biologic therapy is still uncertain. Further studies are needed to determine the most appropriate treatment choice toward ongoing biologic therapy.
肿瘤坏死因子（TNF）阻滞剂在炎症性肠病（IBD）的治疗中的引入，在很大程度上改变了临床医生治疗这些疾病的方式。然而，一些患者在治疗过程中会出现新的免疫介导性疾病。我们在此报告一例克罗恩病患者在使用英夫利昔单抗治疗过程中出现了反常性化脓性汗腺炎，这是一种慢性炎症性皮肤病，其特征是在皱褶部位反复出现结节和脓肿。该患者为 20 岁、非吸烟、体重正常的女性，无化脓性汗腺炎或 IBD 的家族史，于 2013 年诊断为非狭窄性非穿透性回肠结肠克罗恩病。停用英夫利昔单抗后，皮肤病变显著改善。我们还讨论了文献中报道的 22 例使用 TNF 拮抗剂的 IBD 患者中出现的反常性化脓性汗腺炎病例，旨在确定这种并发症发生的潜在危险因素。所有患者均患有克罗恩病，且大多数为女性（19/23；82.6%）。所有病例均发生在使用抗 TNF 药物治疗期间[23 例患者中有 14 例（61%）接受阿达木单抗治疗，9 例（39%）接受英夫利昔单抗治疗]。针对正在进行的生物治疗的维持/保留的治疗方法仍不确定。需要进一步的研究来确定对正在进行的生物治疗的最佳治疗选择。
