インフリキシマブ投与中，自己抗体陽性化後に関節痛と皮疹が出現したベーチェット病の1例

Exanthema and arthralgia following antibodies to infliximab in a case of Behçet disease

要約　目的：インフリキシマブの投与中に関節痛と皮疹が生じたベーチェット病の1例の報告。

症例：33歳女性が頭痛と両眼痛で紹介受診した。

所見と経過：矯正視力は右0.8，左0.6で，両眼で非肉芽腫性汎ぶどう膜炎，再発性口腔内アフタ性潰瘍，結節性紅斑様皮疹があった。HLA-B51が陽性であり，ベーチェット病と診断した。インフリキシマブの全身投与を行い，汎ぶどう膜炎は鎮静化した。27か月後から両手の関節痛が生じ，39か月後に両下腿に瘙痒を伴う皮疹が生じた。53か月後にインフリキシマブ投与に対する反応が生じ，抗インフリキシマブ抗体の関与が疑われた。

結論：インフリキシマブの全身投与中に関節痛や皮疹が生じたときには，抗インフリキシマブ抗体の陽性化に伴う効果減弱や投与時反応が出現する可能性がある。

Abstract　Purpose：To report a case of Behçet disease who developed exanthema and arthralgia following systemic treatment with infliximab.

Case：A 33-year-old female was referred to us for headache and bilateral ocular pain.

Findings and Clinical Course：Corrected visual acuity was 0.8 right and 0.6 left. Both eyes showed nongranulomatous uveitis. She also showed aphthous ulcer and erythema nodosum. She was positive for HLA-B51 and was diagnosed with Behçet disease. Systemic treatment with infliximab was followed by resolution of panuveitis. She developed arthralgia in both hands 27 months later and exanthema in both legs 39 months later. These symptoms exacerbated synchronous with intake of infliximab. Antibodies to infliximab were suspected as the underlying cause.

Conclusion：This case illustrates that exanthema or arthralgia following treatment with infliximab may be due to antibodies to infliximab with negative therapeutic effect.