Abstract
Rheumatoid vasculitis usually occurs on the background of seropositive rheumatoid arthritis, although in rare cases the patients can be seronegative. We report a woman with seronegative rheumatoid arthritis with rheumatoid vasculitis who developed toxic epidermal necrolysis involving most of her body surface area, while on therapy with intravenous cyclophosphamide and mesna. After withdrawal of suspected offending agents, administration of intravenous immunoglobulin, and supportive therapy, she had a favorable outcome. Such an occurrence is rare and serves to educate about a potentially life-threatening adverse event associated with a commonly used immunosuppressive agent.
Zusammenfassung
Eine rheumatoide Vaskulitis tritt meist vor dem Hintergrund einer seropositiven rheumatoiden Arthritis auf, selten auch bei Seronegativität. Berichtet wird über eine Patientin mit seronegativer rheumatoider Arthritis, die unter Therapie mit i.v. Cyclophosphamid und Mesna eine toxische epidermale Nekrolyse im Bereich von nahezu der gesamten Körperoberfläche entwickelte. Nach Sistieren der im Verdacht stehenden Substanzen, i.v. Gabe von Immunglobulinen und Implementierung einer supportiven Therapie kam es zu einem günstigen Verlauf und Outcome. Die Schilderung dieses selten vorkommenden Ereignisses soll für eine potenziell lebensbedrohliche Nebenwirkung in Verbindung mit einem häufig eingesetzten Immunsuppressivum sensibilisieren.
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Conflict of interest. A.C. Chowdhury, D.P Misra, P.S. Patro, and V. Agarwal state that there are no conflicts of interest.
Written informed consent was sought from the patient prior to submitting the article.
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Chowdhury, A., Misra, D., Patro, P. et al. Toxic epidermal necrolysis due to therapy with cyclophosphamide and mesna. Z Rheumatol 75, 200–202 (2016). https://doi.org/10.1007/s00393-015-1632-z
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DOI: https://doi.org/10.1007/s00393-015-1632-z
Keywords
- Rheumatoid vasculitis
- Seronegative rheumatoid vasculitis
- Immunoglobulin
- Adverse drug reaction
- Immunosuppressive agents