Pyoderma gangrenosum following anti-TNF therapy in chronic recurrent multifocal osteomyelitis: drug reaction or cutaneous manifestation of the disease? A critical review on the topic with an emblematic case report

Frontiers in Medicine

Medicine

Maurizio Gattinara¹  Chiara Moltrasio²  Angelo Valerio Marzano³  Maurizio Romagnuolo³  Claudia Iannone⁴  Stefano Cambiaghi⁵ 

[1] Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy;Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy;Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy;Pediatric Dermatology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;

关键词: pyoderma gangrenosum;    chronic recurrent multifocal osteomyelitis;    drug-induced PG;    anti-TNF;    adalimumab;    adverse drug reaction;    pustular lesion;    pustular psoriasis;   

DOI  :  10.3389/fmed.2023.1197273

 received in 2023-03-30, accepted in 2023-05-15,  发布年份 2023

来源: Frontiers

【 摘 要 】

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory disease, clinically characterized by chronic and recurrent episodes of osteoarticular inflammation, that generally presents in children and adolescents. From a dermatological point-of-view, CMRO can be associated with skin rashes mainly including psoriasis, palmoplantar pustulosis and acne. Pyoderma gangrenosum (PG) is a rare immune-mediated inflammatory skin disease classified within the spectrum of neutrophilic dermatoses that, in some cases, has been reported as cutaneous manifestation in CMRO patients. This paper presents a 16-year female patient diagnosed with CMRO, who presented PG lesions located on the lower leg, that arose after the administration of the tumour necrosis factor (TNF)-α inhibitor adalimumab. Cases of PG have been reported in patients being treated with certain medications, including TNF-α antagonists, leading to classified them in a setting aptly termed “drug-induced PG.” In this paper, we discuss the co-occurrence of PG and CRMO, in the light of recent evidence on the pathogenesis of both diseases and giving ample space to a literature review on drug induced PG. In our case, it is plausible that PG could be considered a cutaneous manifestation of CRMO, although the mechanisms underlying this intriguingly relationship remain to be fully unraveled.

【 授权许可】

Unknown   
Copyright © 2023 Romagnuolo, Moltrasio, Iannone, Gattinara, Cambiaghi and Marzano.