Herpes zoster in a patient treated with adalimumab and leflunomide: Case report Adalimumab ve leflunomid ile tedavi edilen bir hastada herpes zoster
Journal of Rheumatology and Medical Rehabilitation, cilt.20, sa.4, ss.149-152, 2009 (Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 20 Sayı: 4
- Basım Tarihi: 2009
- Dergi Adı: Journal of Rheumatology and Medical Rehabilitation
- Derginin Tarandığı İndeksler: Scopus
- Sayfa Sayıları: ss.149-152
- Anahtar Kelimeler: Adalimumab, Arthritis, Herpes zoster, Leflunomide, Rheumatoid
- Yozgat Bozok Üniversitesi Adresli: Evet
Özet
Herpes zoster (HZ) is one of the most common adverse effects reported in clinical trials of tumor necrosis factor (TNF) alpha antagonists. Several drugs used in the treatment of rheumatoid arthritis (RA), including cyclophosphamide, azathioprine, leflunomide, and methotrexate, have been held responsible for the development of HZ. In this report, a case of diagnosed HZ in an adult while receiving combination therapy TNF-alpha antagonist (adalimumab) and leflunomide for rheumatoid arthritis will be presented. The patient was using adalimumab and leflunomide for 18 months without any complications, at the 18th month of her follow-up, she developed an itchy skin rash on the lateral side of the left upper eyelid. Based on dermatologic examination, she was diagnosed with HZ. Systemic valaciclovir treatment was commenced at a dose of 1000mg 3 times daily for 7 days, and adalimumab was stopped. The patient recovered within 7 days without any complications. At the 2nd and 6th months of her follow up she had no swollen or tender joints, the ESR measurements were 69 mm/h and 60 mm/h, her DAS 28 scores were 2.9 and 3.1 respectively. Accordingly these findings we did not restart anti-TNF alpha treatment. Therapy of patient was continued with leflunomide 20 mg/day. Therapy with combined adalimumab and leflunomide may result in various opportunistic infections. This should be kept in mind while prescribing TNF alfa antagonists for patients who are already receiving immunosuppressant drugs. Copyright © 2009 by Türk Tibbi Rehabilitasyon Kurumu Derneg̈i.