Abstract
Tumor necrosis factor alpha (TNF?) inhibitors such as adalimumab and infliximab are biologic agents widely used to good effect for many inflammatory diseases, including rheumatoid arthritis, inflammatory bowel disease, and psoriasis. However, the TNF? antagonism of these agents may increase risk of granulomatous infections. Here we report a case of a 64-year-old black female with a history of seropositive rheumatoid arthritis who was referred to dermatology by rheumatology for evaluation of two new erythematous papules with subcutaneous nodules on the left arm. The patient had been started on adalimumab 5 months prior to presentation and had also been taking methotrexate for several years. Biopsy revealed granulomatous dermatitis with Fite positive organisms, and subsequent PCR detected Mycobacterium leprae. The patient’s adalimumab was discontinued, and hydroxychloroquine was initiated instead. While TNF? inhibitors are important in the management of inflammatory diseases, clinicians and patients should be aware of the potential infectious risk they carry. In these immunocompromised, high-risk patients, findings of granulomatous dermatitis and Fite positive organisms should increase suspicion for diseases such as leprosy and prompt further evaluation in order to identify the organism and focus medical therapy.
Financial Disclosure:
No current or relevant financial relationships exist.