Disseminated Herpes Zoster Mimicking Rheumatoid Vasculitis in a Rheumatoid Arthritis Patient on EtanerceptTresch S. · Trüeb R.M. · Kamarachev J. · French L.E. · Hofbauer G.F.L.
Dermatology Department, University Hospital Zürich, Zürich, Switzerland
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Tumor necrosis factor-α (TNFα)-blocking agents are immunomodulating agents introduced for treatment of a variety of chronic inflammatory disease conditions. Adverse effects include an increased incidence of infections. Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. In our report of a patient on etanercept therapy for rheumatoid arthritis, the correct diagnosis was delayed because disseminated herpes zoster was clinically mimicking vasculitis. Initially assuming rheumatoid vasculitis, immunosuppression was increased, resulting in worsening of skin lesions. Only an extended work-up, including a skin biopsy and viral cultures, established the correct diagnosis. Management of varicella zoster virus (VZV) infection primarily focuses on early initiation of antiviral therapy to control VZV replication. Therapy with intravenous acyclovir followed by oral valacyclovir allowed complete resolution of acute skin changes. In immunosuppressed patients, the possibility of infection with atypical presentation must always be kept in mind, and that this might mimic other disease conditions. Broad differential diagnosis and an extended diagnostic workup help in establishing the correct diagnosis.
© 2009 S. Karger AG, Basel
- Weisman MH, Paulus HE, Burch FX, Kivitz AJ, Fierer J, Dunn M, Kerr DR, Tsuji W, Baumgartner SW: A placebo-controlled, randomized, double-blinded study evaluating the safety of etanercept in patients with rheumatoid arthritis and concomitant comorbid diseases. Rheumatology (Oxford) 2007;46:1122–1125.
- Roberts L, McColl GJ: Tumour necrosis factor inhibitors: risks and benefits in patients with rheumatoid arthritis. Intern Med J 2004;34:687–693.
- Panush RS, Katz P, Longley S, Carter S, Love JJ, Stanley H: Rheumatoid vasculitis: diagnostic and therapeutic decisions. Clin Rheumatol 1983;2:321–330.
- Hata T, Kavanaugh A: Rheumatoid arthritis in dermatology. Clin Dermatol 2006;24:430–437.
- Flendrie M, Vissers WHPM, Creemers MCW, de Jong EMGJ, van de Kerkhof PCM, van Riel PLCM: Dermatological conditions during TNF-alpha-blocking therapy in patients with rheumatoid arthritis: a prospective study. Arthritis Res Ther 2005;7:R666–R676.
- Nishie W, Sawamura D, Iitoyo M, Shimizu H: Intravascular histiocytosis associated with rheumatoid arthritis. Dermatology 2008;217:144–145.
- Lin J, Ziring D, Desai S, Kim S, Wong M, Korin Y, Braun J, Reed E, Gjertson D, Singh RR: TNFalpha blockade in human diseases: an overview of efficacy and safety. Clin Immunol 2008;126:13–30.
- Wendling D, Streit G, Toussirot E, Prati C: Herpes zoster in patients taking TNFalpha antagonists for chronic inflammatory joint disease. Joint Bone Spine 2008;75:540–543.
- Strangfeld A, Listing J, Herzer P, Liebhaber A, Rockwitz K, Richter C, Zink A: Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents. JAMA 2009;301:737–744.
- Wung PK, Holbrook JT, Hoffman GS, Tibbs AK, Specks U, Min Y, Merkel PA, Spiera R, Davis JC, St. Clair EW, McCune J, Ytterberg SR, Allen NB, Stone JH: Herpes zoster in immunocompromised patients: incidence, timing, and risk factors. Am J Med 2005;118:1416.
- Becart S, Segaert S: Recurrent varicella in an adult psoriasis patient treated with etanercept. Dermatology 2008;217:260–261.
Ahmed AM, Brantley JS, Madkan V, Mendoza N, Tyring SK: Managing herpes zoster in immunocompromised patients. Herpes 2007;14:32–36.
- Roxas M: Herpes zoster and postherpetic neuralgia: diagnosis and therapeutic considerations. Altern Med Rev 2006;11:102–113.
Dworkin RH, Johnson RW, Breuer J, et al: Recommendations for the management of herpes zoster. Clin Infect Dis 2007;44(suppl 1):1–26.
Feldmeyer L, Kamarachev J, Boehler A, et al: Molluscum-contagiosum folliculitis mimicking tinea barbae in a lung-transplant recipient. J Am Acad Dermatol, in press.
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