F Bertini

F Falcini

G Carnesecchi

G Lepri

M Matucci Cerinic

Pediatric Rheumatology

PubMed

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POSTER PRESENTATION Open Access
PReS-FINAL-2315: Severe cutaneous vasculitis in
two patients with juvenile idiopathic arthritis and
biologic therapy
F Falcini1*, G Lepri1, G Carnesecchi1, F Bertini1, M Matucci Cerinic2
From 20th Pediatric Rheumatology European Society (PReS) Congress
Ljubljana, Slovenia. 25-29 September 2013
Introduction
The management of chronic inflammatory autoimmune
diseases has been revolutioned by the use of novel biolo-
gic agents achieving excellent results in the treatment of
Juvenile Idiopathic Arthritis (JIA). These drugs are gen-
erally well tolerated but as they are increasingly used,
the incidence of adverse reaction is more common. The
most frequent are localised at the injection’s site; others
include: pustular folliculitis, psoriasis, hydradenitis,
Sweet’s syndrome, lupus-like reactions, and palm plantar
pustolosis. Cutaneous vasculitis related to TNF-alpha
antagonists, such as hypersensitivity and leucocytoclastic
vasculitis, has been described as few case reports.
Conversely, there are no reports of cutaneous vasculitis
induced from other biologic agents. We report two
cases of severe cutaneous vasculitis in adolescents with
JIA and uveitis under biologic therapy.
Objectives
To report cutaneous complications of biologic agents.
Methods
From Database of all JIA patients cared at our clinic
with biologic therapy we look for those with side effects
and we found two patients with cutaneous vasculitis.
Results
Patient 1: Male with JIA ERA onset HLA B27+ and
severe bilateral uveitis since the age of 9 yrs. After
NSAIDs, steroids and MTX, biologics were introduced
due to persistent articular and ocular activity. The
patient developed cutaneous folliculitis with fungal
super infection both during Infliximab infusion, discon-
tinued after 5 years for allergic reaction, and Abatacept
stopped for inefficacy. Therefore Adalimumab was
started with a good control of disease’s activity, but 3
years later the patient developed skin reactions at the
lower limbs. Biopsy revealed leucocytoclastic vasculitis.
The drug was withdrawn and steroid pulses adminis-
tered. Adalimumab was resumed after the disappearance
of the lesions without further complications. Case 2:
Girl with extended oligoarticular IJA and bilateral uveitis
since the age of 2 years. After NSAIDs, steroids, MTX, and
Infliximab, Adalimumab was introduced followed by ingu-
inal and axillary skin lesions like psoriasis. Due to relapse
of arthritis Abatacept was substituted to Adalimumab. At
the second infusion, patient developed cutaneous reaction
at the lower limbs classified by biopsy as leucocytoclastic
vasculitis. The lesions improved after drug withdrawn and
steroid administration.
Conclusion
Biologics are effective and safe in JIA. As more and more
widely used the adverse effects are more and more fre-
quent. Our cases confirm the just reported vasculitic
reactions under antiTNF-alpha drugs, and highlights that
this event can also occur also with non-anti TNF-alpha
biologic drugs.
Disclosure of interest
None declared.
Authors’ details
1Internal Medicine, Rheumatology Section, Transition Clinic, Florence, Italy.
2Internal Medicine, Rheumatology Section, University of Florence, Florence,
Italy.
1Internal Medicine, Rheumatology Section, Transition Clinic, Florence, Italy
Full list of author information is available at the end of the article
Falcini et al. Pediatric Rheumatology 2013, 11(Suppl 2):P305
http://www.ped-rheum.com/content/11/S2/P305
© 2013 Falcini et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited. 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.
Published: 5 December 2013
doi:10.1186/1546-0096-11-S2-P305
Cite this article as: Falcini et al.: PReS-FINAL-2315: Severe cutaneous
vasculitis in two patients with juvenile idiopathic arthritis and biologic
therapy. Pediatric Rheumatology 2013 11(Suppl 2):P305.
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Falcini et al. Pediatric Rheumatology 2013, 11(Suppl 2):P305
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PReS-FINAL-2315: Severe cutaneous vasculitis in two patients with juvenile idiopathic arthritis and biologic therapy

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PReS-FINAL-2315: Severe cutaneous vasculitis in two patients with juvenile idiopathic arthritis and biologic therapy

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