ORAL AND CUTANEOUS LICHENOID REACTION DUE TO ABATACEPT TREATMENT FOR RHEUMATOID ARTHRITIS

• Published in: Oral surgery, oral medicine, oral pathology and oral radiology Vol. 137; no. 6; p. e225
• Main Authors: de CÁCERES, Cinthia Veronica Bardález López, LOUREDO, Brendo Vinicius Rodrigues, FURTADO DE OLIVEIRA, Luiz Filipe Nakasone Peel, FUIM, Ana Márcia Vieira, CHRISTIANO, Luiz Felipe Saddi, VARGAS, Pablo Agustin, ASSUNÇÃO JUNIOR, José Narciso Rosa
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.06.2024
• ISSN: 2212-4403; 2212-4411
• DOI: 10.1016/j.oooo.2023.12.376

The purpose is to present an unusual case of a paradoxical reaction associated with Abatacept, a T-cell costimulation modulator used in rheumatoid arthritis (RA) patients. A 63-year-old female patient diagnosed with RA, receiving treatment with sulfasalazine and abatacept, developed painful oral lesions over two months. An extraoral examination revealed widespread pruritic, brownish macules and plaques on the skin. Intraorally, ulcerated lesions were observed on the lower lip, labial commissures, buccal mucosa, tongue, hard and soft palate. A forearm biopsy indicated chronic lichenoid dermatitis, leading to the prescription of prednisolone and fluconazole. A biopsy of the oral mucosa showed hyperparakeratosis and ulceration, accompanied by a dense subepithelial lymphocytic inflammation, suggesting a diagnosis of a drug-induced lichenoid reaction. The rheumatologist discontinued Abatacept. One month later, the patient achieved complete remission. Presently, the patient is free from oral and skin lesions and continues RA therapy with prednisolone.