Macrophage Activation Syndrome Upon Initiation of Adalimumab in a Patient With Longstanding Rheumatoid Arthritis

Celestin Chicos; Milana Zirkiyeva; Sabiha Bandagi; Adriana Abrudescu

doi:10.7759/cureus.12825

Macrophage Activation Syndrome Upon Initiation of Adalimumab in a Patient With Longstanding Rheumatoid Arthritis

Cureus. 2021 Jan 20;13(1):e12825. doi: 10.7759/cureus.12825.

Authors

Celestin Chicos¹, Milana Zirkiyeva¹, Sabiha Bandagi², Adriana Abrudescu²

Affiliations

¹ Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA.
² Rheumatology, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA.

Abstract

Macrophage activation syndrome (MAS) is a subset of hemophagocytic lymphohistiocytosis (HLH) described in patients with rheumatological disorders. Some triggers of MAS and HLH include infection, malignancy, rheumatological disease, HIV, and rarely medications such as immunosuppressants. In recent medical literature, biologic agents are increasingly recognized as a potential trigger, but the mechanism behind this remains poorly understood. We describe the case of a patient who developed MAS after initiating adalimumab and propose a potential pathophysiological link between biologics and this syndrome.

Keywords: adalimumab; biologics; hemophagocytic lymphohistiocytosis; macrophage activation syndrome; rheumatoid arthritis.

Publication types

Case Reports