Cutaneous Actinomycosis Associated with Anti-TNF-Alpha Therapy: Report of Two Cases

• Published in: Dermatology (Basel) Vol. 228; no. 2; pp. 112 - 114
• Main Authors: Breton, A.L., Lamblin, G., Pariset, C., Jullien, D.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2014
• Subjects: Actinomycosis - chemically induced; Actinomycosis - diagnosis; Actinomycosis - drug therapy; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antibodies, Monoclonal - adverse effects; Antirheumatic Agents - adverse effects; Arthritis, Rheumatoid - drug therapy; Bacterial infections; Case and Review; Dermatologic Agents - adverse effects; Etanercept; Female; Humans; Immunoglobulin G - adverse effects; Inflammatory diseases; Infliximab; Middle Aged; Psoriasis - drug therapy; Receptors, Tumor Necrosis Factor; Risk Factors; TNF inhibitors; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Infliximab; Etanercept; Actinomycosis
• ISSN: 1018-8665; 1421-9832
• DOI: 10.1159/000357522

Increased susceptibility to infections is among the main safety concerns raised by anti-TNF-α agents. We describe two cases of cutaneous actinomycosis in patients undergoing anti-TNF-α therapy: a 49-year-old female treated with etanercept for rheumatoid arthritis and a 57-year-old female treated with infliximab for psoriasis. Both patients had discharge with the intermittent presence of sulfur granules occurring at the site of previous surgical wounds. Bacteriological culture demonstrated Actinomyces. Since in both cases laboratory findings and medical imaging ruled out visceral actinomycosis, oral antibiotics were introduced without discontinuing anti-TNF-α. The first patient did not relapse after 2 years. The second one did and received a second course of antibiotics combined with transient interruption of the anti-TNF-α therapy. The risk of developing actinomycosis is reported to be similar in immunocompetent and immunocompromised patients, however cases of cutaneous actinomycosis occurring during anti-TNF-α therapy need to be recognized and may be under-reported.