[Interstitial pneumonia after infliximab therapy for psoriasis]

Abstract

Background: Tumour necrosis factor (TNF)-alpha inhibitors are increasingly used for treatment of severe psoriasis. Hypersensitivity pneumonia is a rare but frequently fatal side-effect of such therapy that is unknown to most dermatologists.

Patients and methods: A 68-year-old woman was hospitalized for subacute dyspnoea, fever, dry cough and basal chest pain 3 months after beginning infliximab therapy for severe psoriasis. Blood tests revealed an inflammatory syndrome and hypoxaemia. Thoracic computed tomography showed bilateral basal interstitial infiltrates with pleural effusion. The results of bronchoalveolar lavage and of the other microbiology testing were negative. Probabilistic treatment with amoxicillin/clavulanic acid and spiramycin was ineffective. We suspected drug-induced alveolitis and began corticosteroid therapy which improved dyspnoea, gas exchange and X-ray images.

Discussion: Hypersensitivity pneumonia is a potential pulmonary complication of anti-TNF alpha therapy and is frequently fatal. We report the first case of interstitial pneumonia secondary to infliximab given for severe psoriasis without any other pneumotoxic agents. Clinical features include dry cough, dyspnoea, and fever of acute or subacute onset. A diagnosis of allergic alveolitis was retained after elimination of other possible causes of the patient's interstitial pneumonia.

Conclusion: The indications for anti-TNF agents are increasing in dermatology, and it is thus vital to consider their very rare but serious complications such as hypersensitivity pneumonia.