DOI: https://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20222730
Published: 2022-10-27

A rare case of infliximab induced myeloperoxidase-cytoplasmic antineutrophil cytoplasmic autoantibody positive cutaneous vasculitis

Carly J. Robinson, Neil K. Jairath, Jon C. Davis, Hongyu H. Yang

Abstract


Drug-induced cutaneous vasculitis is a known autoimmune complication of tumor necrosis factor (TNF) inhibitors with many instances resulting in the production of newly formed antibodies. We report a 21-year-old female with a past medical history of Crohn’s disease controlled with infliximab who presented to dermatology with a purpuric rash and crusted plaques of her distal lower extremities. Biopsy of a lesion revealed perivascular lymphocytes, neutrophils and eosinophils, vessel wall damage, and dermal eosinophils consistent with a drug-induced vasculitis. Follow up labs assessing for antibodies revealed unusual findings of an elevated cytoplasmic-antineutrophil cytoplasmic autoantibody (C-ANCA) titer and myeloperoxidase (MPO) antibody level making this patient MPO-C-ANCA positive. The patient’s lesions were treated with both oral and topical steroids, colchicine, and transition of her infliximab to ustekinumab with subsequent improvement of her lesions and normalization of antibody titers.


Keywords


TNF inhibitors, Cutaneous vasculitis, C-ANCA, MPO antibody

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References


Shagroni TT, Cazares A, Kim JA, Furst DE. Nonsteroidal anti-inflammatory drugs, disease modifying antirheumatic drugs, nonopioid analgesics and drugs used in gout. In: Katzung BG, Vanderah TW, eds. Basic and Clinical Pharmacology, McGraw Hill. 2021;36.

Sangle SR, Hughes GR, D'Cruz DP. Infliximab in patients with systemic vasculitis that is difficult to treat: poor outcome and significant adverse effects. Ann Rheum Dis. 2007;66(4):564-5.

Giorgio V, Blasi E, Rigante D, Guerriero C, De Simone C, Fedele AL et al. Anti-TNF-related leukocytoclastic vasculitis in ulcerative colitis: a case report. Int J Environ Res Public Health. 2021;18(13):6711.

Sokumbi O, Wetter DA, Makol A, Warrington KJ. Vasculitis associated with tumor necrosis factor-α inhibitors. Mayo Clin Proc. 2012;87(8):739-45.

Atzeni F, Turiel M, Capsoni F, Doria A, Meroni P, Sarzi-Puttini P. Autoimmunity and anti-TNF-alpha agents. Ann N Y Acad Sci. 2005;1051:559-69.

Radice A, Sinico RA. Antineutrophil cytoplasmic antibodies (ANCA). Autoimmunity. 2005;38(1):93-103.

Segelmark M, Baslund B, Wieslander J. Some patients with anti-myeloperoxidase autoantibodies have a C-ANCA pattern. Clin Exp Immunol. 1994;96(3):458-65.

Koratala A, Wakefield DN, Alquadan KF, Ahsan Ejaz A. MPO-C-ANCA-associated necrotising and crescentic glomerulonephritis. JRSM Open. 2017;8(4):2054270417692710.

Lim G, Lim S, Tee SI, Ling CY. A challenging diagnosis of MPO-C-ANCA EGPA. BMJ Case Rep. 2019;12(7):e228621.