Interstitial granulomatous dermatitis following tocilizumab, a paradoxical reaction?

Interstitial granulomatous dermatitis (IGD) is a rare dermatosis generally seen in the setting of rheumatic diseases, but also hematological disorders, internal malignances, infections, or drug induced. Herein, we report an exceptional case of an IGD with a clear chronological association with tocil...

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Bibliographic Details
Published in:Dermatologic therapy 2020-11, Vol.33 (6), p.e14207-n/a
Main Authors: Altemir, Arcadi, Iglesias‐Sancho, Maribel, Sola‐Casas, María de los Ángeles, Novoa‐Lamazares, Luis, Fernández‐Figueras, Maite, Salleras‐Redonnet, Montse
Format: Article
Language:English
Subjects:
Adult
Antibodies, Monoclonal, Humanized - adverse effects
Dermatitis - diagnosis
Dermatitis - drug therapy
Dermatitis - etiology
Granuloma - chemically induced
Granuloma - diagnosis
Granuloma - drug therapy
Granuloma Annulare - chemically induced
Granuloma Annulare - diagnosis
Granuloma Annulare - drug therapy
granulomatous drug reaction
Humans
interleukin‐6 inhibitors
interstitial granulomatous dermatitis
paradoxical reaction
tocilizumab
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Summary:Interstitial granulomatous dermatitis (IGD) is a rare dermatosis generally seen in the setting of rheumatic diseases, but also hematological disorders, internal malignances, infections, or drug induced. Herein, we report an exceptional case of an IGD with a clear chronological association with tocilizumab onset and cessation in a patient with adult‐onset Still's disease. We review the granulomatous cutaneous reactions so far reported with this novel therapy: sarcoidosis, granuloma annulare, and IGD. Tocilizumab is a humanized anti‐interleukin 6 receptor monoclonal antibody useful for the treatment of various systemic inflammatory disorders. Lately, it has found useful also for granulomatous diseases such as giant cell arteritis and even a promising response in IGD. Therefore, we believe our case adds the possibility of an IGD presenting as a paradoxical reaction.
ISSN:1396-0296
1529-8019
DOI:10.1111/dth.14207