AB1004 LUPUS LIKE SYNDROME ASSOCIATED WITH INFLIXIMAB TREATMENT IN CHILDHOOD: CASE SERIES OF TWO PATIENT
Authors: duygu kurtulus, Ferhat Demir, Betül Sözeri
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Drug-induced lupus (DIL) caused by medication is a form of lupus erythematosus. When the medication is stopped, disease symptoms generally disappears in in days or months. Infliximab is an anti-TNF chimeric antibody widely used and approved for the treatment of many diseases. TNF-α antagonist induced lupus-like syndrome (TAILS) is among the uncommon side effects of infliximab. TAILS is a clinical syndrome with features similar to SLE, but with some differences in laboratory and clinical findings. <h3>Objectives</h3> We have presented our experience with lupus like syndrome emerge after infliximab treatment in two children. <h3>Methods</h3> We evaluated the clinical properties of 2 patients who were monitored with diagnoses of juvenile idiopathic arthritis and uveitis symptoms and developed TAILS after infliximab treatment. <h3>Results</h3> First patient applied to our pediatric rheumatology outpatient clinic with a complaint of swelling in the left knee continuing for 1 month. During the physical examination, we found arthritis on the left knee. During the eye examination, it was discovered that he had bilateral pars planitis. Anti-nuclear antibodies were found positive at 1/320 titration, and anti-dsDNA was negative. Following JIA and accompanying uveitis diagnoses, methylprednisolone and methotrexate treatment was started for the patient. After treatment, the patient whose joint and eye symptoms started to regress, was subjected to lesser dose of methylprednisolone, but the uveitis attack of the patient started to occur again. We added infliximab treatment to its treatment that was resistant to uveitis. At the 6-month of infliximab treatment, there was no uveitis attack observed. During remission, after 6. dose of infliximab treatment, there were complaints of tiredness and polyarthralgia. It was observed that the patient had arthritis in several joints. After the re-studied laboratory tests, there was anti-dsDNA antibody positivity. We thought the patient developed TAILS, and stopped the infliximab treatment. After stopping the treatment, complaints of tiredness and polyarthralgia, as well as arthritis symptoms were improved, and anti-dsDNA antibody levels returned back to normal. The second, 15-year-old patient was being monitored by pediatric rheumatology outpatient clinic with oligoarticular JIA diagnosis since the age of 1. The patient had also uveitis on the right eye since the age of 6. During methylprednisolone, methotrexate, and azathioprine treatment, there were uveitis attacks that developed at different periods. We started infliximab treatment for uveitis of the patient. After 2. dose of infliximab, the patient started to complain about migraine style headaches that occurred once or twice a week. In redone laboratory tests, ANA (at 1/320 titration), anti-cardiolipin antibody, and anti-beta2 glyco-protein antibody were found positive. There was also low levels of C3 and C4 detected. The infliximab treatment was stopped for the patient who was diagnosed with TAILS. After stopping treatment, the headache complaints regressed, and auto-antibody positivity's turned back to normal. <h3>Conclusion</h3> Although the development of ANA anti-dsDNA antibodies during infliximab therapy is common, TAILS is rare, especially in the pediatric population. In patients develop SLE findings under infliximab infusion, TAILS must be considered and the drug should be discontinued. <h3>References</h3> <h3>Acknowledgement</h3> We are grateful to all participating children and their families. All the participants and their legal guardians were informed, and their written consent was obtained. Disclosure of Interest: None Declared <h3>Disclosure of Interests</h3> None declared