Table 1: Reactive granulomatous dermatitis during anti-TNF therapy: literature review.
| Authors, year [Ref] | F/M (age) | Diagnosis | TNFa agent | Concurrent treatment | Duration of use | Type of gronulomatous lesions | Location | Discontinuation of TNFa | Treatment and Outcome |
|---|---|---|---|---|---|---|---|---|---|
| Present case, 2016 | M (56) | PA | ADA | MTX | 20 m | Skin erythematous patches of 20-30 mm of diameter and plaques, infiltrated nodules | Cheek, nose, forehead | Withdrawal | CS and ciprofloxacin, doxycycline, metronidazole - no improvement; HCQ - resolved |
| Palisaded Neutrophilic and Granulomatous Dermatitis (PNGD) | |||||||||
| Bremner, et al. [25] | |||||||||
| #1 | F (57) | RA | IFX | MTX | 3 m | Annular papules and plaques | Medial thighs, axillary folds, back | nr | DPS - improved |
| #2 | F (27) | RA | IFX | MTX | nr | Papules/Vescicles and papules | Buttocks, posterior thighs/palms, fingers | nr | CS DPS HCQ - modest improvement |
| #3 | F (54) | RA | ETA | nr | nr | Nodules | Legs and feet | ETN replaced with INF | Topical TCR - modest improvement |
| Deng, et al. [16] | |||||||||
| #1 | F (48) | RA | IFX | nr | Generalized annular nodules and plaques | Back and shoulders | Withdrawal | Improved, lost follow-up | |
| #2 | F (65) | RA | IFX | nr | Macules and plaques | Flank and forearm | Withdrawal | Resolved | |
| #3 | F (34) | RA | ETA | MTX | nr | Papules | Elbows | Withdrawal | Lesions persistence |
| Collaris EJ, et al. [22] | M (57) | RA | IFX | - | 9 m | PNGD plaques | Nose/extensor elbow | No | Topical metronidazole resolved/topical CS resolved |
| Stephenson SR, et al. [13] | F (56) | RA | ADA | MTX, CS | 24 m | PNGD patches and plaques | Legs | Withdrawal | AZA, CS - cleared |
| Umezawa Y, et al. [26] | F (64) | RA | ADA | CS | 10 m | PNGD papules erythema, purpura | Hands, plantae | Withdrawal | Topical CS - cleared after ADA discontinuation |
| de Unamuno Bustos B, et al. [27] | F (41) | AS/RA | ETA/ADA | - | 18 m/8 m | PNGD erythematous papules | Forearms and elbows/fingers | Withdrawal | Topical CS resolved/persistence in TCZ |
| Interstitial Granulomatous Dermatitis (IGD) | |||||||||
| Patsatsi, et al. [28] | F (70) | RA | ADA | - | 1 m after withdrawal | IGD papules | Umbilicus | Withdrawal and re-initiation | Non response to topical CS, resumed ADA |
| Guerin, et al. [29] | F (61) | RA | ADA | 7 m | IGD plaques | Lower extremities | Withdrawal | CS, LFM - resolved | |
| Interstitial Granulomatous Drug Reaction (IGDR) | |||||||||
| Martorell, et al. [30] | F (45) | PA | ADA | 6 m | Nodules | Legs | Withdrawal | Cleared | |
Legend: F: Female; M: Male; RA: Rheumatoid Arthtritis; AS: Axial Spondyloarthritis; PA: Psoriatic Arthritis; PNGD: Palisaded Neutrophilic and Granulomatous Dermatitis; IGD: Interstitial Granulomatous Dermatitis; IFX: Infliximab; ADA: Adalimumab; ETA: Etanercept; MTX: Methotrexate; CS: Corticosteroids; nr: not recorded; DPS: Dapsone; HCQ: Hydroxychloroquine; TCR: Tacrolimus; AZA: Azathioprine; TCZ: Tocilizumab; LFM: Leflunomide.