Paradoxical Reaction to Golimumab: Tumor Necrosis Factor α Inhibitor Inducing Psoriasis Pustulosa

Abstract

Importance: Golimumab is a human monoclonal antibody, used for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Adverse reactions are increasing with this class of medication (tumor necrosis factor α inhibitors).

Observations: The authors present a case of a female patient who presented with psoriasis pustulosa after the use of golimumab for rheumatoid arthritis.

Conclusions and relevance: Paradoxically, in this case, golimumab, which is used for psoriasis, induced the pustular form of this disease. We are observing an increasing number of patients who develop collateral effects with tumor necrosis factor α inhibitors, and the understanding of the mechanism of action and how these adverse reactions occur may contribute to avoid these sometimes severe situations.

Keywords: Golimumab; Paradoxical reaction; Psoriasis pustulosa; Tumor necrosis factor α inhibitor.

Figures

Fig. 1

Pustular palmar lesions, associated with erythema and desquamation.

Fig. 2

Pustular lesions on the soles.

Fig. 3

Pustules in the center of erythematous-desquamative lesions of the lower limbs.

Fig. 4

Epidermis with acanthosis and exuberant exocytosis of neutrophils, which in segment configure Kogoj's spongiform pustule; note also dilation of the capillaries of the papillary dermis. HE. ×10.

Fig. 5

Detail of Kogoj's spongiform pustule: accumulation of neutrophils in the upper portions of the Malpighi layer. HE. ×40.