Biologic Agent-Associated Cutaneous Adverse Events: A Single Center Experience

Abstract

Biologic agents are regarded as an effective treatment for a variety of autoimmune diseases. These drugs have an acceptable safety and tolerability profile, although an increasing number of autoimmune conditions have been reported with their use. Additionally, a variety of cutaneous diseases have been associated with their use. Here we report our experience of adverse cutaneous events with the use of biologic agents. An alternative explanation for patients presenting with adverse cutaneous events including drug interactions must be carefully investigated.

Keywords: Adverse drug events; Anti-TNF therapy; Autoimmune disease; Biologic agents; Cutaneous vasculitis.

Figure 1

(A, B) Cutaneous rash while on etanercept. (C, D) 8 weeks after discontinuation of etanercept and initiation of adalimumab the rash has disappeared.

Figure 2

(A) Biopsy of the left lateral abdomen shows mild superficial dermal edema and interstitial and perivascular inflammation (10X, hematoxylin and eosin). (B) High power image showing that the majority of the inflammatory cells are interstitial and perivascular neutrophils. The blood vessels fail to show vascular damage (20X, hematoxylin and eosin).

Figure 3

Figure showing extent and distribution of cutaneous vasculitis lesions on (A) the foot and (B) inner thigh of the patient on certolizumab.

Figure 4

Biopsy of the left medial dorsal foot shows prominent extravasated red blood cells with associated neutrophils with leukocytoclasis and perivascular fibrin deposition, consistent with a leukocytoclastic vasculitis (20X, hematoxylin and eosin).

Figure 5

(A, B) Sections of the mediastinal lymph node show diffuse non-necrotizing granulomatous inflammation, consistent with sarcoidosis. Special stains [(A) GMS and (B) FITE] were negative for micro-organisms.

Figure 6

Red and scaly discoid lesions (A) over back, (B) under breasts and (C) under the pannus in patient on tocilizumab.

Figure 7

Sections showing psoriasiform epidermal hyperplasia with neutrophilic parakeratosis. There is suprapapillary plate thinning with prominent dermal blood vessels within dermal papillae and superficial perivascular lymphocytic infiltrate within the dermis. These findings would be in keeping with the histologic findings of psoriasis.