[Berger's disease associated to an adalimumab-treated rheumatoid arthritis]

Berger's disease is characterized by deposits of immunoglobulin A in the glomerular mesangium. We report a case of a patient who was treated by adalimumab for a rheumatoid arthritis (RA). The patient is 45 years old and is treated for RA since 1996. Adalimumab was started after the failure of several treatments. Biological and clinical response to adalimumab were excellent. A nephrotic syndrome was diagnosed during the patient follow-up. Adalimumab was stopped since it was suspected to be responsible of these symptoms. Berger's disease was diagnosed thanks to a renal biopsy. The nephrotic syndrome was treated with corticosteroids, then tocilizumab was used to treat RA. TNF-alpha inhibitors are well known for inducing kidneys' adverse reactions (ADR). Usually, they appear shortly after the beginning of a treatment. Adalimumab has already been described in studies for inducing similar kidneys' adverse drug reactions. These ADR are often associated with systemic disease outbreak. It is difficult to assert that adalimumab or RA was responsible of the ADR that we noticed in our patient. It is usually admitted that these ADR are uncommon when the RA is controlled.