[Interstitial pneumonia after infliximab therapy for psoriasis]

Area of Science:

• Pulmonology
• Dermatology
• Pharmacology

Background:

• Tumor necrosis factor (TNF)-alpha inhibitors are increasingly prescribed for severe psoriasis.
• Hypersensitivity pneumonia is a rare, potentially fatal side effect of TNF-alpha inhibitor therapy, often unrecognized by dermatologists.

Observation:

• A 68-year-old woman developed subacute dyspnea, fever, cough, and chest pain three months after starting infliximab for psoriasis.
• Imaging revealed bilateral interstitial infiltrates and pleural effusion; microbiology was negative.
• Initial antibiotic treatment failed, leading to suspicion of drug-induced alveolitis.

Findings:

• The patient's symptoms and imaging findings were consistent with hypersensitivity pneumonia secondary to infliximab.
• Corticosteroid therapy led to significant improvement in respiratory symptoms, gas exchange, and radiographic findings.
• This case highlights interstitial pneumonia as a complication of anti-TNF therapy, even without concurrent pneumotoxic agents.

Implications:

• Dermatologists must be aware of hypersensitivity pneumonia as a rare but serious complication of anti-TNF therapy.
• Prompt diagnosis and initiation of corticosteroid treatment are vital for managing this potentially fatal condition.
• Increased use of anti-TNF agents necessitates vigilance for their uncommon but severe pulmonary side effects.