アダリムマブ投与によって生じたparadoxical reaction

・今回われわれは，アダリムマブ（Adalimu­mab：ADA）投与後に生じたparadoxical reaction（PR）を経験したので報告する．

・本症は，TNF-α阻害薬により形質細胞様樹状細胞（plasmacytoid dendritic cell：pDC）からのIFN-α産生が亢進した結果，サイトカインバランスの不均衡がおこり，Th1細胞による炎症が惹起され生じると推察されている．

・TNF-α阻害薬使用中に生じた乾癬の悪化時は，TNF-α阻害薬の二次無効による悪化に加えPRも常に念頭に置く必要がある．

（「症例のポイント」より）

　

A case of paradoxical reaction caused by Adalimumab

　

Watanabe, Kousuke1）Yokouchi, Yuki2）Fukuda, Hidetsugu1） 1）Department of Dermatology, Toho University Ohashi Medical Center 2）Department of Pathology, Toho University Ohashi Medical Center

　

Paradoxical reactions (PR) induced by TNF-inhibitor (TNF-I) are now well known. We report a case of PR caused by TNF-I (adalimumab：ADA). A 45-year-old woman vised our hospital with erythema with the scale on the whole body. We diagnosed the lesion as psoriasis vulgaris (PSO.V). Sixteen weeks after the first injection of TNF-I (adalimumab：ADA), the eruptions improved. But after 35 weeks, she had a fever with the exacerbation of the eruptions. From these findings, we diagnosed the lesions as PR.