Granuloma Annulare, Drug-Induced Lupus and

Publication

Granuloma Annulare, Drug-Induced Lupus and

Case Report

Journal Paper/Review - Apr 17, 2017

Popp Florian, Fischer S, Kempf W, von Kempis Johannes, Welcker M, Müller Rüdiger

Citation

Popp F, Fischer S, Kempf W, von Kempis J, Welcker M, Müller R. Granuloma Annulare, Drug-Induced Lupus and - Case Report. Clinical Image: Annals of Clinical Case Reports 2017; 2

Type

Journal Paper/Review (English)

Journal

Clinical Image: Annals of Clinical Case Reports 2017; 2

Publication Date

Apr 17, 2017

Issn Print

2474-1665

Publisher

Remey Publications LLC.

Brief description/objective

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.