Tocilizumab-Induced Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome in Adult-Onset Still Disease
Authors: Elina Zuelgaray, Fanny Domont, Nathan Peiffer-Smadja, David Saadoun, Patrice Cacoub
Journal: Annals of Internal Medicine (2017)

Letters18 July 2017Tocilizumab-Induced Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome in Adult-Onset Still DiseaseElina Zuelgaray, MD, Fanny Domont, MD, Nathan Peiffer-Smadja, MD, David Saadoun, MD, PhD, and Patrice Cacoub, MD, PhDElina Zuelgaray, MDFrom Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Universités, INSERM, and CNRS, Paris, France., Fanny Domont, MDFrom Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Universités, INSERM, and CNRS, Paris, France., Nathan Peiffer-Smadja, MDFrom Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Universités, INSERM, and CNRS, Paris, France., David Saadoun, MD, PhDFrom Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Universités, INSERM, and CNRS, Paris, France., and Patrice Cacoub, MD, PhDFrom Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Universités, INSERM, and CNRS, Paris, France.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0592 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Adult-onset Still disease is a systemic inflammatory condition characterized by spiking fevers; polyarthritis; and an evanescent, salmon-pink, maculopapular rash. Affected persons have high ferritin levels, a high leukocyte count with neutrophil predominance, and low glycosylated ferritin levels. Tocilizumab is a humanized monoclonal antibody against the interleukin-6 receptor that is used to treat refractory adult-onset Still disease. This drug can cause adverse cutaneous events, such as mild maculopapular rash, urticaria, and pruritus (1).Objective: To describe what we believe is the first reported case of severe adverse cutaneous effects from tocilizumab.Case Report: A 55-year-old woman was hospitalized for a ...References1. Smolen JS, Beaulieu A, Rubbert-Roth A, Ramos-Remus C, Rovensky J, Alecock E, et al; OPTION Investigators. Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial. Lancet. 2008;371:987-97. [PMID: 18358926] doi:10.1016/S0140-6736(08)60453-5 CrossrefMedlineGoogle Scholar2. Cacoub P, Musette P, Descamps V, Meyer O, Speirs C, Finzi L, et al. The DRESS syndrome: a literature review. Am J Med. 2011;124:588-97. [PMID: 21592453] doi:10.1016/j.amjmed.2011.01.017 CrossrefMedlineGoogle Scholar3. Villiger PM, Adler S, Kuchen S, Wermelinger F, Dan D, Fiege V, et al. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet. 2016;387:1921-7. [PMID: 26952547] doi:10.1016/S0140-6736(16)00560-2 CrossrefMedlineGoogle Scholar4. Sparsa L, Afif N, Bularca S, Fricker A, Thiebault S, Dahan E, et al. [Paradoxical cutaneous reactions associated with tocilizumab therapy]. Rev Med Interne. 2014;35:613-6. [PMID: 24630585] doi:10.1016/j.revmed.2014.01.007 CrossrefMedlineGoogle Scholar5. Izquierdo JH, Bonilla-Abadía F, Ochoa CD, Agualimpia A, Tobón GJ, Cañas CA. Acute generalized exanthematous pustulosis due to tocilizumab in a rheumatoid arthritis patient. Case Rep Rheumatol. 2012;2012:517424. [PMID: 23304614] doi:10.1155/2012/517424 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Universités, INSERM, and CNRS, Paris, France.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L16-0592.This article was published at Annals.org on 23 May 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTocilizumab-Induced Dermatosis in a Patient With Rheumatoid ArthritisRuxolitinib reduces severe CRS response by suspending CAR-T cell function instead of damaging CAR-T cellsTocilizumab and its usage for skin diseasesCutaneous Adverse Reactions to Biologic AgentsCritical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse ReactionsImmunogenicity of biologic agents in rheumatologyDiagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper'Toxic erythema' and eosinophilia associated with tocilizumab therapy in a COVID‐19 patientTocilizumab 18 July 2017Volume 167, Issue 2Page: 141-142KeywordsAdverse reactionsDrugsEnzymesFerritinFeversLeukocytosisLiverLiver diseasesRashesSystemic diseases ePublished: 23 May 2017 Issue Published: 18 July 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...