Anti-TNF-Related Medium-Vessel Vasculitis: A Report of a Rare Adverse Drug Reaction

TL;DR

A rare case of medium-vessel vasculitis caused by anti-TNF therapy in a rheumatoid arthritis patient is reported, highlighting the need for vigilance in monitoring skin reactions.

Contribution

This paper presents a rare adverse drug reaction of anti-TNF-induced vasculitis in a seronegative rheumatoid arthritis patient.

Findings

A 33-year-old patient developed medium-vessel vasculitis after starting certolizumab pegol.

Skin biopsy confirmed vasculitis, which improved after discontinuing the drug and starting corticosteroids.

The case emphasizes the importance of considering vasculitis in new skin lesions during biologic therapy.

Abstract

Tumor necrosis factor (TNF) inhibitors have significantly improved outcomes for patients with rheumatoid arthritis (RA). However, these biologic agents can lead to rare but serious adverse events, including drug-induced vasculitis. We report a rare case of anti-TNF-induced medium-vessel vasculitis in a 33-year-old female with seronegative RA and a complex medical history. After inadequate responses and adverse effects from previous treatment, the patient was switched to anti-TNF certolizumab pegol. Shortly after initiation, she developed painful, erythematous, and pruritic rashes on her hands and arms. A skin biopsy confirmed medium-vessel vasculitis. The condition improved following the discontinuation of certolizumab and initiation of immunosuppressive therapy with corticosteroids. This case underscores the importance of vigilance for dermatologic adverse effects in patients receiving TNF inhibitors. Vasculitis should be considered as a differential diagnosis when new skin lesions appear during biologic therapy, and management should be initiated accordingly.

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