Development of leprosy in a patient with rheumatoid arthritis during treatment with etanercept: a case report

Semin Arthritis Rheum. 2012 Oct;42(2):127-30. doi: 10.1016/j.semarthrit.2012.03.003. Epub 2012 Apr 26.

Abstract

Background: Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder. There is a clear association between some disease-modifying drugs used to treat RA and infection. The introduction of the anti-tumor necrosis factor (TNF) therapies has improved the outcome of severe RA. The TNF-antagonism may increase susceptibility to granulomatous pathogens such as Mycobacterium tuberculosis, Listeria monocytogenes, and Histoplasma capsulatum.

Methods: We report the case of a 37-year-old woman with RA receiving an anti-TNF agent, who developed a rash on her back and both legs, which was finally diagnosed as tuberculoid leprosy.

Results: This is the first case of leprosy due to anti-TNF therapy reported in Europe.

Conclusions: Clinicians should be aware of this and other types of atypical and serious infections that patients may suffer from when treated with anti-TNF agents.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antirheumatic Agents / adverse effects*
  • Arthritis, Rheumatoid / drug therapy*
  • Dapsone / therapeutic use
  • Drug Substitution
  • Etanercept
  • Female
  • Humans
  • Immunocompromised Host
  • Immunoglobulin G / adverse effects*
  • Leprostatic Agents / therapeutic use
  • Leprosy, Tuberculoid / drug therapy
  • Leprosy, Tuberculoid / etiology*
  • Receptors, Tumor Necrosis Factor
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Withholding Treatment

Substances

  • Antirheumatic Agents
  • Immunoglobulin G
  • Leprostatic Agents
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Dapsone
  • Etanercept