Psoriasiform eruption induced by adalimumab in a patient with rheumatoid arthritis : a case report and review of literature

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A 72-year-old man developed arthritis of the bilateral shoulders and fingers. X-ray examination of the fingers showed periarticular osteoporosis, joint space narrowing, and cystic changes at the bone ends. Because contrast-enhanced MRI revealed synovial membrane proliferation and osteolysis, a diagnosis of rheumatoid arthritis (RA) was made. Treatment for RA with methotrexate (4 mg/week) was initiated in December 2008. In February 2009, adalimumab administration (40 mg/2 weeks) was initiated. The RA markedly improved, and clinical remission was maintained thereafter. However, in April 2010, relatively well-delineated erythematous plaques accompanied by bullae and scales developed on the bilateral palms, toes, limbs, and the inguinal region. A diagnosis of psoriasis-like eruptions was made by skin biopsy, and adalimumab administration was discontinued. After 4 months, the eruptions improved. Psoriasis-like eruptions due to anti-TNF drugs are rarely observed, but adverse effects require caution. This case is reported along with a review of the literature.