Interstitial granulomatous dermatitis following tocilizumab, a paradoxical reaction?

Arcadi Altemir, Maribel Iglesias-Sancho, María de Los Ángeles Sola-Casas, Luis Novoa-Lamazares, Maite Fernández-Figueras, Montse Salleras-Redonnet

Dermatologic therapy 2020 Nov

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Interstitial granulomatous dermatitis (IGD) is a rare dermatosis generally seen in the setting of rheumatic diseases, but also hematological disorders, internal malignances, infections, or drug induced. Herein, we report an exceptional case of an IGD with a clear chronological association with tocilizumab onset and cessation in a patient with adult-onset Still's disease. We review the granulomatous cutaneous reactions so far reported with this novel therapy: sarcoidosis, granuloma annulare, and IGD. Tocilizumab is a humanized anti-interleukin 6 receptor monoclonal antibody useful for the treatment of various systemic inflammatory disorders. Lately, it has found useful also for granulomatous diseases such as giant cell arteritis and even a promising response in IGD. Therefore, we believe our case adds the possibility of an IGD presenting as a paradoxical reaction. © 2020 Wiley Periodicals LLC.

Citation

Arcadi Altemir, Maribel Iglesias-Sancho, María de Los Ángeles Sola-Casas, Luis Novoa-Lamazares, Maite Fernández-Figueras, Montse Salleras-Redonnet. Interstitial granulomatous dermatitis following tocilizumab, a paradoxical reaction? Dermatologic therapy. 2020 Nov;33(6):e14207