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Various toxicities: case report A 38-year-old woman developed various toxicities while receiving infliximab for rheumatoid arthritis (RA), followed by tocilizumab and abatacept for rheumatoid vasculitis (RV). The woman, who was diagnosed with RA in April 2006, was initially treated with methotrexate and prednisolone. As this treatment was ineffective, she received her first injection of infliximab 170mg (3 mg/kg) in April 2008. After her second infliximab dose [frequency not stated], skin eruptions temporarily appeared on her extremities as a side effect of infliximab. Infliximab was discontinued, and the woman’s skin eruptions resolved. In August 2008, she was diagnosed with RV, after which she received etanercept, followed by adalimumab and tacrolimus. Due to insufficient treatment, adalimumab was switched to tocilizumab 400 mg/body in January 2010 [route and frequency not stated]. This treatment was also ineffective and not tolerated, with the development of periodontal abscesses [duration of treatment to reaction onset not stated], leading to tocilizumab withdrawal in June. In August, tacrolimus was switched to azathioprine; however, due to leukocytopenia and thrombocytopenia this drug was stopped, and tacrolimus was resumed. In October 2010, the woman started receiving abatacept 500mg [route and frequency not stated]. Her RV symptoms subsequently improved, and her doses of prednisolone and methotrexate could be reduced. However, she developed headache, nausea and vomiting during the night after each abatacept administration that lasted 3–7 days. She subsequently received paracetamol [acetaminophen], granisetron and glucocorticoids before each dose of abatacept, and her symptoms became tolerable. Author comment: "Our patient suffered headache and nausea as side effects of the abatacept treatment." Fujii W, et al. The rapid efficacy of abatacept in a patient with rheumatoid vasculitis. Modern rheumatology / the Japan Rheumatism Association 22: 630-634, No. 4, Aug 2012. Available from: URL: http://dx.doi.org/10.1007/ 803079051 s10165-011-0559-8 - Japan

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Reactions 27 Oct 2012 No. 1425