Tumor necrosis factor inhibitor-induced cutaneous lupus: A case report and literature review

Introduction

Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine that plays a key role in regulating immune responses. TNF-α inhibitors are widely used to treat immune-mediated diseases, but their increasing use is associated with a rise in adverse events. Case Presentation: We report the case of a 65-year-old man with chronic psoriasis and positive antinuclear antibodies (ANA) with fine speckled pattern, previously treated with topicals, phototherapy, cyclosporine, and dimethyl fumarate without achieving disease control (PASI 12). The TNF-α inhibitor adalimumab was initiated, leading to significant improvement (PASI 3) after 3 months. However, the patient progressively developed hypochromic, erythematous lesions on the face, neck, and periungual areas. Repeat ANA testing showed a homogeneous and nucleolar pattern, and biopsy confirmed subacute cutaneous lupus. Adalimumab was discontinued, and tildrakizumab (anti-interleukin-23p19) was initiated, resulting in complete resolution of the lupus lesions and psoriasis clearance (PASI 0) after 6 months.