Paradoxical mucocutaneous flare in a case of Behçet’s disease treated with tocilizumab
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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.
KeywordsBehçet’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.
- 6.Cantarini L, Vitale A, Scalini P, Dinarello CA, Rigante D, Franceschini R, et al. (2013) Anakinra treatment in drug-resistant Behçet’s disease: a case series. Clin Rheumatol [Epub ahead of print].Google Scholar
- 11.Caso F, Iaccarino L, Bettio S, Ometto F, Costa L, Punzi L, et al. (2013) Refractory pemphigus foliaceus and Behçet’s disease successfully treated with tocilizumab. Immunol Res 56:390–397Google Scholar