Certolizumab pegol
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Eosinophilic fasciitis: case report A 24-year-old man developed eosinophilic fasciitis (EF) during treatment with certolizumab pegol for ankylosing spondylitis (AS). The man was referred with a 5-month history of stiffness and skin induration of the extremities. Two years previously, he was diagnosed with AS. Following initial therapy with sulfasalazine and unspecified NSAIDs, he started receiving certolizumab pegol [dosage and route not stated]. Subsequently, he developed transient red, itchy ’bumps’ on the extremities along with peripheral blood eosinophilia. The manifestation was suspected to be due to certolizumab pegol. Certolizumab pegol was discontinued following which the man experienced progressive limb stiffness and skin tightness during exercise. Therefore, secukinumab was started due to his persisting axial complaints. Further history showed weight loss, partly due to switch to vegan diet. Laboratory tests revealed peripheral eosinophilia, mild increased ESR and CRP, polyclonal hypergammaglobulinaemia, normal creatine kinase and negative antinuclear antibody assay. Capillaroscopy finding was normal. A contrast-enhanced MRI of his arm demonstrated fascial inflammation with subcutaneous oedema. A full-thickness wedge biopsy including fascia, subcutis, skin and muscle of his left upper arm was done. Histology demonstrated a dense lymphocytic infiltrate in the fascia, thereby confirming the diagnosis of EF, which was attributed to certolizumab pegol [duration of treatment to reaction onset not stated]. He was treated with prednisolone, methotrexate and physiotherapy. Following rapid normalisation of his eosinophil count and inflammatory markers, prednisolone was tapered to discontinuation. Further, his underlying AS was in remission, and he exhibited complete resolution of skin tightness at the arms with mild residual induration in his legs. In addition, his peripheral eosinophil counts remained normal. Debusschere C, et al. Development of eosinophilic fasciitis during treatment with certolizumab pegol for ankylosing spondylitis. Clinical and Experimental Rheumatology 38: 803516030 799, No. 4, Jul-Aug 2020. Available from: URL: https://pubmed.ncbi.nlm.nih.gov/32242807/
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Reactions 21 Nov 2020 No. 1831
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