Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 21, 2009; 15(35): 4449-4452
Published online Sep 21, 2009. doi: 10.3748/wjg.15.4449
Stevens-Johnson syndrome complicating adalimumab therapy in Crohn’s disease
Muna Salama, Ian Craig Lawrance
Muna Salama, Department of Gastroenterology, Fremantle Hospital, Fremantle 6059, WA, Australia
Ian Craig Lawrance, Department of Gastroenterology, Fremantle Hospital, WA, Australia; Centre for Inflammatory Bowel Diseases, Fremantle Hospital, WA Australia; Department of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle 6059, WA, Australia
Author contributions: Salama M and Lawrance IC contributed to the writing and analysis of this case report
Correspondence to: Ian Craig Lawrance, Professor, Department of Medicine and Pharmacology, University of Western Australia, T Block, Fremantle Hospital, Alma Street, Fremantle 6059, WA, Australia. ian.lawrance@uwa.edu.au
Telephone: +61-8-94316347 Fax: + 61-8-94313160
Received: December 26, 2008
Revised: August 25, 2009
Accepted: September 1, 2009
Published online: September 21, 2009
Abstract

The anti-tumor necrosis factor (TNF)α medications demonstrate efficacy in the induction of remission and its maintenance in numerous chronic inflammatory conditions. With the increasing number of patients receiving anti-TNFα agents, however, less common adverse reactions will occur. Cutaneous eruptions complicating treatment with an anti-TNFα agent are not uncommon, occurring in around 20% of patients. Adalimumab, a fully humanized antibody against TNFα, may be expected to cause minimal immune-mediated skin reactions compared to the chimeric monoclonal antibody, infliximab. We, however, report a case of Stevens-Johnson syndrome that required hospitalization and cessation of adalimumab in a patient with Crohn’s disease (CD). In this case report, a 29-year-old male with colonic and perianal CD with associated erythema nodosum and large joint arthropathy developed severe mucositis, peripheral rash and desquamation, fevers and respiratory symptoms concomitant with a second dose of 40 mg adalimumab after a 2 mo break from adalimumab therapy. Skin biopsies of the abdominal wall confirmed erythema multiforme and the patient was on no other drugs and infective etiologies were excluded. The patient responded rapidly to IV hydrocortisone and was able to be commenced on infliximab without recurrence of the Stevens-Johnson syndrome. Desquamating skin reactions have now been described in three of the TNFα antagonists (infliximab, etanercept and adalimumab). These reactions can be serious and prescribers need to be aware of the potential mucocutaneous side effects of these agents, especially as Stevens-Johnson syndrome is associated with significant morbidity and mortality.

Keywords: Stevens-Johnson syndrome; Crohn’s disease; Adalimumab; Serious adverse effect