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A 28-year-old female patient with Crohn’s disease presented with progressive arthralgia, morning
stiffness and a rash on her upper limbs. Symptoms developed insidiously during certolizumab-pegol
(CZP) therapy. In parallel an increase of ANA developed (homogeneous, 1:320). ENA-screening,
including histone antibodies, was negative. Histopathologically a granuloma annulare (GA) was
diagnosed and in summary, diagnosis of a drug-induced lupus (DIL) was clinically established.
Treatment cessation with CZP resulted in regression of these symptoms (Figure 1-3).
DIL is a typical adverse event of TNF-antagonists [1,2]. Appearance of GA as a symptom during
TNF-antagonists therapy is rare and only in case reports documented [3-5]. No case of GA was
described to our knowledge neither secondary to CZP therapy nor in association with DIL.
Occurrence of GA during TNF-antagonists therapy should be considered for new unclear skin
manifestations. A routine clinical examination including ANA-titer measurement is recommended
during TNF-antagonists therapy.