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Double Infection in a Patient with Psoriatic Arthritis Under TNF-alpha Blockers Therapy: A Case Report

Benedetto Caroleo1, Alberto Migliore2, Erika Cione3

  • 1Department of Medical and Surgical Science, School of Medicine, University of Catanzaro and Elderly Disease Operative Unit Mater Domini Hospital, Catanzaro, Italy.

Current Drug Safety
|January 17, 2019
PubMed
Abstract

Insights

Patients on tumor necrosis factor (TNF)-alpha blockers for psoriatic arthritis developed rare leishmaniasis and non-tubercular mycobacterial lung infections. Early diagnosis and treatment are crucial for managing these serious infections in immunosuppressed patients.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Dermatology

Background:

  • Psoriatic arthritis (PA) is often treated with tumor necrosis factor (TNF)-alpha inhibitors.
  • These therapies can increase the risk of opportunistic infections.
  • Adalimumab is a common TNF-alpha blocker used for PA treatment.

Observation:

  • A patient with PA on adalimumab developed a skin wound and subsequent lung infection.
  • The skin infection was diagnosed as leishmaniasis, likely linked to adalimumab.
  • The patient later developed a non-tubercular mycobacterial lung infection while on apremilast.

Findings:

  • Leishmaniasis was diagnosed in a psoriatic arthritis patient treated with adalimumab.
  • A non-tubercular mycobacterial infection occurred in the same patient during apremilast therapy.
  • Discontinuation of adalimumab and apremilast, with appropriate treatments, led to patient recovery.

Implications:

  • Clinicians should consider leishmaniasis and non-tubercular mycobacterial infections in PA patients on TNF-alpha inhibitors.
  • Vigilance for opportunistic infections is essential during immunosuppressive therapy.
  • This case underscores the need for careful monitoring and prompt management of infections in patients with autoimmune diseases.
Keywords:
HR-CTPsoriatic arthriatisTNF-alpha inhibitorsbDMARDlung infectionskin-knees ulcer.

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