Clinical Rheumatology

, Volume 34, Issue 6, pp 1141–1143 | Cite as

Paradoxical mucocutaneous flare in a case of Behçet’s disease treated with tocilizumab

  • Luca Cantarini
  • Giuseppe Lopalco
  • Antonio Vitale
  • Laura Coladonato
  • Donato Rigante
  • Orso Maria Lucherini
  • Giovanni Lapadula
  • Florenzo Iannone
Case Based Review


We report on a patient with a long-standing history of recurrent oral aphthosis and pseudofolliculitis, diagnosed with Behçet’s disease (BD), previously treated with high-dose prednisone, colchicine, cyclosporine, cyclophosphamide and methotrexate, all of which were partially effective. Treatment with the chimeric mouse-human anti-tumour necrosis factor (TNF)-α monoclonal antibody infliximab brought about the resolution of mucocutaneous lesions for a period of 6 years. After an oral and articular BD relapse, the anti-interleukin-6 agent tocilizumab was started in association with high-dose prednisone. Unexpectedly, the patient experienced a paradoxical mucocutaneous flare following tocilizumab administration, which worsened after the second infusion. Tocilizumab was then discontinued, and total recovery was achieved after the patient was started on the fully human anti-TNF-α monoclonal antibody golimumab in association with colchicine and methylprednisolone.


Behçet’s disease (BD) Genital ulcers Golimumab Oral aphthosis Tocilizumab 


Conflict of interest

Luca Cantarini: Grant/Research support from Novartis, SOBI; Consultant: Novartis, SOBI. The other authors have disclosed no conflicts of interest.


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Copyright information

© Clinical Rheumatology 2014

Authors and Affiliations

  • Luca Cantarini
    • 1
  • Giuseppe Lopalco
    • 2
  • Antonio Vitale
    • 1
  • Laura Coladonato
    • 2
  • Donato Rigante
    • 3
  • Orso Maria Lucherini
    • 1
  • Giovanni Lapadula
    • 2
  • Florenzo Iannone
    • 2
  1. 1.Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le ScotteUniversity of SienaSienaItaly
  2. 2.Interdisciplinary Department of Medicine, Rheumatology Unit, Policlinic HospitalUniversity of BariBariItaly
  3. 3.Institute of PediatricsUniversità Cattolica Sacro CuoreRomeItaly

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