Introduction. Axial spondylarthritis is a chronic inflammatory disease that involves primarily the axial skeleton. In recent years, tumor necrosis factor inhibitors have been widely used as an effective treatment in rheumatology practice. Despite the generally safe reputation of these biological agents, there have been rare reports of adverse effects including leukocytoclastic vasculitis.
Case presentation. A 48-year-old male with a history of diabetes mellitus and hypertension presented for morning stiffness, chest discomfort, and back pain, most severe at night during rest. His laboratory tests yielded results within the reference values and a positive HLA B27. Magnetic resonance imaging showed clear signs of edemas in the sacrum and ilium near both sacroiliac joints. Based on the findings and the Assessment of Spondyloarthritis International Society-European Alliance of Associations for Rheumatology criteria, the patient was diagnosed with radiographic axial spondyloarthritis. After 22 months of adalimumab therapy, the patient reported fatigue and the appearance of skin lesions. The diagnosis of leukocytoclastic vasculitis was confirmed by the histopathological examination of the skin biopsy. Three weeks after adalimumab discontinuation, there was a complete resolution of the skin lesions.
Conclusions. Leukocytoclastic vasculitis is an uncommon adverse effect of adalimumab, that should be considered for improved disease management and treatment.
Keywords: adalimumab, axial spondylarthritis, leukocytoclastic vasculitis, TNF-α inhibitors
Full text sources https://doi.org/10.31688/ABMU.2024.59.4.14
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Aldo SHPUZA
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