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Related Experiment Video

Updated: Apr 16, 2026

The bm12 Inducible Model of Systemic Lupus Erythematosus SLE in C57BL/6 Mice
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Adalimumab-induced lupus serositis.

Dearbhla Kelly1, Oisin O'Connell1, Michael Henry1

  • 1Department of Respiratory Medicine, Cork University Hospital and School of Medicine, Cork, Ireland.

BMJ Case Reports
|March 6, 2015
PubMed
Summary

Adalimumab, used for ankylosing spondylitis, can cause drug-induced lupus, leading to serositis. Withdrawal of the medication resolved the patient's symptoms, highlighting the link between anti-TNF-α agents and autoimmunity.

Area of Science:

  • Rheumatology
  • Immunology
  • Pulmonology

Background:

  • Adalimumab is a biologic therapy targeting tumor necrosis factor-alpha (TNF-α), commonly used for inflammatory conditions like ankylosing spondylitis.
  • Drug-induced lupus erythematosus (DILE) is a recognized, albeit less common, adverse effect of various medications, including biologic agents.
  • Serositis, characterized by inflammation of the pleura and pericardium, can be a presenting symptom of DILE.

Observation:

  • A 61-year-old male on adalimumab for ankylosing spondylitis for two years presented with dyspnea, chest pain, and lethargy.
  • Clinical examination revealed pleural and pericardial effusions.
  • Video-assisted thoracoscopic surgery (VATS) biopsy of the pleura showed eosinophils, acute inflammatory cells, and lymphoid aggregates.

Findings:

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  • The patient tested positive for antinuclear, antidouble-stranded, and antihistone antibodies.
  • These autoantibodies, in conjunction with the clinical presentation and biopsy findings, were consistent with drug-induced lupus erythematosus.
  • The patient's serositis resolved completely after the discontinuation of adalimumab.

Implications:

  • This case underscores the potential for anti-TNF-α agents like adalimumab to induce autoimmunity and trigger DILE in susceptible individuals.
  • Early recognition and drug withdrawal are crucial for managing DILE and resolving associated symptoms such as serositis.
  • Physicians should maintain a high index of suspicion for DILE in patients on TNF-α inhibitors presenting with unexplained serositis or other lupus-like symptoms.