Tofacitinib
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Tofacitinib Inguinal lymphadenopathy: case report
A 49-year-old woman developed inguinal lymphadenopathy following treatment with tofacitinib for rheumatoid arthritis. The woman, who had seropositive rheumatoid arthritis, was initiatlly treated with unspecified steroids, methotrexate and hydroxychloroquine. Following 18 months, her rheumatoid arthritis still persisted. Therefore, methotrexate was continued, and tofacitinib 10 mg/day [route not stated] was added to her treatment. After 2 months, a prompt response with tofacitinib was noted. After 1 year from the tofacitinib initiation, she developed bilateral inguinal lymph nodes, which were painless but progressive in size. Biopsy of the inguinal lymph node exhibited chronic lymphadenitis with absence of the characteristic epithelioid granuloma, intense inflammation, caseous necrosis and fibrosis. Pelvic MRI and abdominal ultrasound showed disease confined to the inguinal region. In the following days, she displayed continuous secretion of purulent material in the right groin inguinal region, which tested negative for fungi and alcohol acid-resistant staining. The woman’s treatment with tofacitinib was discontinued. She received unspecified broad spectrum antibiotics including quinolones and azithromycin. However, no evident clinical response was noted. She was hospitalised for persistent lymphadenitis and was treated with daily cleansing dressing and third-generation cephalosporins. Later, she was started on isoniazide, pyrazinamide, rifampicin and ethambutol for 9 months. A gradual improvement was noted. Two months after therapy discontinuation, complete resolution of the inguinal lymphadenitis was noted, which persisted until her last visit in December 2017. The inguinal lymphadenopathy was considerd possibly related to the tofacitinib usage. At the time of this report writing, she was on methotrexate with an improvement in her rheumatoid arthritis. Gomides AP, et al. Chronic inguinal lymphadenitis in a patient with rheumatoid arthritis being treated with tofacitinib: Remission with antituberculous therapy and discontinuation of JAK inhibition. JCR: Journal of Clinical Rheumatology 26: e138-e139, No. 5, Aug 2020. Available from: URL: http://doi.org/10.1097/ RHU.0000000000001017
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Reactions 5 Dec 2020 No. 1833
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