Erythema multiforme during anti-tumor necrosis factor treatment for plaque psoriasis

Tumor necrosis factor alpha (TNF-alpha) inhibitors constitute a class of biologic treatments utilized in the management of psoriasis. We report a case of a patient treated for chronic plaque psoriasis with the anti-TNF-alpha monoclonal antibody adalimumab, who developed erythema multiforme (EM). The patient had previously developed EM on two occasions while taking the TNF-alpha inhibitor etanercept. EM has previously been reported in connection with other TNF-alpha inhibitors, including etanercept and infliximab. To our knowledge, this is the first case reported in the literature documenting EM occurring subsequent to adalimumab treatment for psoriasis. The recurrent development of EM in our patient while being treated with distinct TNF-alpha inhibitors may suggest that EM is the consequence of a class effect with TNF-alpha inhibitors.