Etanercept
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¨ First report of Henoch-Schoenlein purpura: case report A 60-year-old woman developed Henoch-Sch¨ oenlein purpura during treatment with etanercept for rheumatoid arthritis. Three months after starting etanercept [dosage not stated], the woman developed a purpuric skin eruption and microscopic haematuria, in association with an episode of sinusitis. Her erythrocyte sedimentation rate (ESR) was 80 mm/h. IgA and IGM rheumatoid factors were present and antinuclear antibody was positive. Antistreptolysin O was positive at 300/L (normal 0–200). She had polyclonal expansion of immunoglobulins and low level polyclonal cryoglobinaemia. A skin biopsy showed leucocytoclastic vasculitis with C3 deposition. A renal biopsy showed segmental and focal glomerulonephritis and immunohistochemistry showed diffuse, granular deposits of IgA and C3 in the mesangium. The woman was diagnosed with Henoch-Sch¨ oenlein purpura. She received IV methylprednisolone followed by monthly cyclophosphamide, with resolution of her clinical symptoms, proteinuria, haematuria and immunoglobulin levels. Etanercept was restarted several months later and the woman developed sinusitis and a purpuric skin eruption [dosage and time to reaction onset not stated]. Her ESR was 50 mm/h and she had microscopic haematuria and proteinuria. The results of a renal biopsy and blood tests were consistent with Henoch-Sch¨ oenlein purpura. [Patient outcome not stated.] Author comment: "The recurrence of upper respiratory tract infection with positive antistreptolysin O test in the setting of TNF-α inhibition may explain the onset of [HenochSch¨ oenlein purpura]." Duffy TN, et al. Henoch Schonlein purpura following etanercept treatment of rheumatoid arthritis. Clinical and Experimental Rheumatology 24 (Suppl. 41): 106, 801046075 No. 2, Mar-Apr 2006 - Switzerland
» Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of Henoch-Sch¨ oenlein purpura associated with etanercept. The WHO Adverse Drug Reactions database contained one report of purpura allergic associated with etanercept.
0114-9954/10/1121-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 30 Sep 2006 No. 1121
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