acyclovir and Spondylitis--Ankylosing

Tumor necrosis factor-α (TNF-α) antagonists, most of which are monoclonal antibodies, became a widespread treatment for autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel diseases, psoriasis, psoriatic arthritis, hidradenitis suppurativa and uveitis. Their use is based on the blockage of TNF-α, which plays an important role in granulomas formation, development of phagosomes, activation and differentiation of macrophages, immune response against viral pathogens. The multiple adverse effects of TNF-α inhibition have been identified, including a two-to four-fold increased risk of active tuberculosis and other granulomatous conditions and an increased occurrence of some other serious bacterial, fungal and certain viral infections.. A 34-year-old male patient with disseminated varicella and pneumonitis was admitted to our hospital. The diagnosis of varicella was established serologically by enzyme immunoassay (EIA) and by polymerase chain reaction confirmation of the virus in vesicular fluid. The patient has been receiving adalimumab and methotrexate for the last 3 years due to ankylosing spondylitis and was seropositive to varicella zoster virus prior to the introduction of TNF-α antagonists. Acyclovir was administered for 10 days with the resolution of clinical illness and radiological signs of pneumonitis.. Due to the use of biological agents, particularly TNF-α inhibitors, as a well-established therapy for some autoimmune diseases, new potential adverse events can be expected in the future and we wanted to point out one of them. To our knowledge this is the first case of recurrent disseminated varicella in a patient taking TNF-α antagonists.

Topics: Acyclovir; Adalimumab; Adult; Anti-Inflammatory Agents; Chickenpox; Herpesvirus 3, Human; Humans; Male; Methotrexate; Pneumonia; Spondylitis, Ankylosing

It is unclear whether immunosuppression is a risk factor for herpes encephalitis. Herein, we describe a rare case of herpes simplex virus type 2 encephalitis in a patient treated with low-dose methotrexate for HLA-B27-associated spondyloarthritis. The patient was successfully treated with acyclovir but presented sequelae of encephalitis. Here we discuss the possible role of low-dose methotrexate therapy as a risk factor of neurological herpes reactivation and severe disease. The host-related and viral risk factors are also addressed.

Topics: Acyclovir; Aged; Antiviral Agents; Contraindications, Drug; Encephalitis, Herpes Simplex; Gene Expression; HLA-B27 Antigen; Humans; Immunosuppressive Agents; Male; Methotrexate; Risk Factors; Spondylitis, Ankylosing

Topics: Acyclovir; Anti-Inflammatory Agents; Antirheumatic Agents; Antiviral Agents; Drug Substitution; Drug Therapy, Combination; Edema; Face; Female; Glucocorticoids; Humans; Hydrocortisone; Injections, Intravenous; Meningitis, Aseptic; Middle Aged; Neck; Prednisolone; Spondylitis, Ankylosing; Sulfasalazine; Treatment Outcome

To assess the rate of occurrence and outcomes of herpes zoster in patients taking TNFalpha antagonists.. Retrospective review of the medical records of 300 patients who received TNFalpha antagonists to treat chronic inflammatory joint disease.. We identified 9 (9/300, 3%) patients who experienced herpes zoster, 6 women and 3 men, with rheumatoid arthritis (n=7) or ankylosing spondylitis (n=2). The drug was infliximab in 4 patients, adalimumab in 2 patients, and etanercept in 3 patients, including 2 patients with a prior history of infliximab therapy (for 12 and 36 months, respectively). Mean treatment duration at the occurrence of herpes zoster was 27 months (range, 6-42 months).. Glucocorticoid therapy (n=7) and methotrexate therapy (n=6) were the only risk factors identified in our study. Mean follow-up was 26 months. All 9 patients achieved a full recovery with antiviral treatment and interruption of the TNFalpha antagonist. One patient experienced a recurrence after resuming TNFalpha antagonist therapy.. The scant data in the literature suggest a higher risk of herpes zoster with anti-TNFalpha antibodies than with the soluble receptor. The role for concomitant treatments (glucocorticoids and methotrexate) should be taken into account.

Topics: Acyclovir; Adalimumab; Adult; Aged, 80 and over; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Antiviral Agents; Arthritis, Rheumatoid; Drug Therapy, Combination; Etanercept; Female; Glucocorticoids; Herpes Zoster; Humans; Immunoglobulin G; Immunosuppressive Agents; Infliximab; Male; Methotrexate; Middle Aged; Receptors, Tumor Necrosis Factor; Retrospective Studies; Risk Factors; Spondylitis, Ankylosing; Tumor Necrosis Factor-alpha; Valacyclovir; Valine