Case Report
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World J Gastrointest Pharmacol Ther. Oct 6, 2010; 1(5): 119-122
Published online Oct 6, 2010. doi: 10.4292/wjgpt.v1.i5.119
Henoch-Schönlein purpura complicating adalimumab therapy for Crohn’s disease
Farooq Z Rahman, Gagandeep K Takhar, Ovishek Roy, Anna Shepherd, Stuart L Bloom, Sara A McCartney
Farooq Z Rahman, Gagandeep K Takhar, Ovishek Roy, Stuart L Bloom, Sara A McCartney, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
Anna Shepherd, Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
Author contributions: Rahman FZ and McCartney SA wrote the article; all authors were involved in the patient’s diagnosis and management and reviewed the article.
Correspondence to: Dr. Farooq Z Rahman, BSc(Hons), PhD, MRCP, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU, United Kingdom. f.rahman@ucl.ac.uk
Telephone: +44-207-3809126 Fax: +44-207-380-9162
Received: June 13, 2010
Revised: September 9, 2010
Accepted: September 16, 2010
Published online: October 6, 2010
Abstract

Anti-tumour necrosis factor-α (TNF) therapy has revolutionised the management of chronic inflammatory conditions. With ever increasing numbers of patients being treated with these agents, uncommon adverse reactions will inevitably occur more frequently. Cutaneous manifestations are associated with many of these chronic conditions and can complicate anti-TNF therapy in about 20% of cases. Vasculitic complications are rarely associated with anti-TNF therapy. Henoch-Schönlein purpura (HSP), a small vessel vasculitis, has been described following infliximab and etanercept therapy but never with adalimumab, a fully humanized TNF antibody. The risk of such immune-mediated reactions is theoretically less with adalimumab compared to infliximab but can still occur. Here we report the first case in the literature of HSP that can be attributed to the use of adalimumab in a 19-year-old male with recalcitrant Crohn’s disease.

Keywords: Henoch-Schönlein purpura; Adalimumab; Anti-TNF therapy; Leukocytoclastic vasculitis; Crohn's disease