Certolizumab-induced lichenoid eruption in a patient with rheumatoid arthritis. Issue 12 (9th December 2021)

• Record Type: Journal Article
• Authors: Kunadia, Anuj; Shulman, Kenneth; Sami, Naveed
• Is Part Of: BMJ case reports. Volume 14:Issue 12(2021)
• Publication Date: 2021-12-09
• Subjects: dermatology -- drug interactions -- immunology -- rheumatoid arthritis; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2021-245875
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Certolizumab is a monoclonal antibody against tumour necrosis factor-alpha (TNF-α) commonly used in rheumatologic conditions such as rheumatoid arthritis. Skin rashes are an uncommon side effect with few cases of lichenoid drug eruption reported in the literature. We describe a patient with rheumatoid arthritis who presented 6 weeks after initiating certolizumab pegol. Physical examination showed pink-to-violaceous papules on her upper and lower extremities. Biopsy confirmed a lichenoid drug eruption. The medication was discontinued and she was treated with topical steroids and a calcineurin inhibitor, with resolution of her lesions. Clinicians should be cognizant of such adverse reactions to TNF-α inhibitors and keep drug-induced lichenoid eruptions on the differential. Lichenoid eruptions induced by certolizumab pegol may affect the skin and/or mucous membranes. While most cases occur within weeks to months of starting therapy, eruptions may occur years after treatment initiation, underscoring the importance of a thorough review of medications.