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Intense Pulsed Light Therapy for Lupus Pernio

in 2008 in which Diaz et al described a patient treated with adalimumab for rheumatoid arthritis whose lesions developed 2 months after the start of biologic treatment; and the third reported by Adenis-Lamarre et al in 2009 in a patient with rheumatoid arthritis receiving adalimumab who developed skin lesions and was subsequently diagnosed with M chelonae infection. Our case differs from those described above in the duration of treatment of the patient with adalimumab (6 years) because in the other cases reported, the infection developed within a few months of the start of treatment. We are also of the opinion that our patient’s osteomyelitis may also have been caused by the M chelonae infection, although this hypothesis could not be confirmed by histology or microbiology because the patient had already been receiving appropriate antibiotic therapy for 15 days when samples were obtained. In conclusion, anti-TNF therapy has been associated with opportunistic infections and patients receiving such therapy should be considered to be immunosuppressed. The risk level for infection due to nontuberculous mycobacteria in these patients is not yet known. However, the frequent presence of additional risk factors, such as concomitant treatment with other immunosuppressants (corticosteroids, methotrexate) and the underlying disease itself, make it difficult to estimate the specific weight of these new drugs in the process.