A case report of severe recurrent varicella in an ankylosing spondylitis patient treated with adalimumab – a new side effect after 15 years of usage

Skuhala, Tomislava and Atelj, Anita and Prepolec, Jelena and Al-Mufleh, Mahmoud and Stanimirović, Andrija and Vukelić, Dalibor (2019) A case report of severe recurrent varicella in an ankylosing spondylitis patient treated with adalimumab – a new side effect after 15 years of usage. BMC Infectious Diseases, 19 (1). ISSN 1471-2334

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Background: Tumor necrosis factor-α (TNF-α) antagonists, most of which are monoclonal antibodies, became a widespread treatment for autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel diseases, psoriasis, psoriatic arthritis, hidradenitis suppurativa and uveitis. Their use is based on the blockage of TNF-α, which plays an important role in granulomas formation, development of phagosomes, activation and differentiation of macrophages, immune response against viral pathogens. The multiple adverse effects of TNF-α inhibition have been identified, including a two-to four-fold increased risk of active tuberculosis and other granulomatous conditions and an increased occurrence of some other serious bacterial, fungal and certain viral infections. ----- Case presentation: A 34-year-old male patient with disseminated varicella and pneumonitis was admitted to our hospital. The diagnosis of varicella was established serologically by enzyme immunoassay (EIA) and by polymerase chain reaction confirmation of the virus in vesicular fluid. The patient has been receiving adalimumab and methotrexate for the last 3 years due to ankylosing spondylitis and was seropositive to varicella zoster virus prior to the introduction of TNF-α antagonists. Acyclovir was administered for 10 days with the resolution of clinical illness and radiological signs of pneumonitis. ----- Conclusion: Due to the use of biological agents, particularly TNF-α inhibitors, as a well-established therapy for some autoimmune diseases, new potential adverse events can be expected in the future and we wanted to point out one of them. To our knowledge this is the first case of recurrent disseminated varicella in a patient taking TNF-α antagonists.

Item Type: Article
Additional Information: © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
MeSH: Acyclovir / therapeutic use ; Adalimumab / adverse effects ; Adalimumab / therapeutic use ; Adult ; Anti-Inflammatory Agents / adverse effects ; Anti-Inflammatory Agents / therapeutic use ; Chickenpox / drug therapy ; Chickenpox / etiology ; Chickenpox / virology ; Herpesvirus 3, Human / isolation & purification ; Humans ; Male ; Methotrexate / therapeutic use ; Pneumonia / complications ; Pneumonia / diagnosis ; Spondylitis, Ankylosing / complications ; Spondylitis, Ankylosing / diagnosis ; Spondylitis, Ankylosing / drug therapy
Departments: Katedra za infektologiju
Depositing User: Kristina Berketa
Status: Published
Skuhala, TomislavaUNSPECIFIED
Prepolec, JelenaUNSPECIFIED
Al-Mufleh, MahmoudUNSPECIFIED
Stanimirović, AndrijaUNSPECIFIED
Vukelić, DaliborUNSPECIFIED
Date: 7 February 2019
Date Deposited: 18 Dec 2019 12:00
Last Modified: 18 Dec 2019 12:01
Subjects: /
Related URLs:
URI: http://medlib.mef.hr/id/eprint/3529

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