Login Register Cart 0
Generic placeholder image

Current Drug Safety

Editor-in-Chief

ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Case Report

Tofacitinib-induced Ramsay- Hunt Syndrome in a Patient with Rheumatoid Arthritis

Author(s): Senol Kobak*

Volume 16, Issue 1, 2021

Published on: 19 August, 2020

Page: [107 - 109] Pages: 3

DOI: 10.2174/1574886315999200819153827

Price: $65

Abstract

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint and systemic involvement. Tofacitinib is a JAK- inhibitor that is an effective agent in the treatment of active RA. Varicella zoster virus(VZV) reactivation is among the most important adverse effects of tofacitinib. Ramsay-Hunt syndrome(RHS) is a rare clinical condition that develops as a result of VZV reactivation and progresses with hearing loss, dizziness, and facial nerve paralysis.

Objective: To present a case of Ramsay-Hunt syndrome due to varicella zoster reactivation in a RA patient using tofacitinib.

Case Report: A 63-year-old female RA patient under tofacitinib treatment was admitted to the rheumatology outpatient clinic due to widespread skin rashes on her face and ear, and hearing loss. On inspection widespread erythematous, vesicular rashes on the left side of the face, lips, around the eye and in the ear, and mild facial paralysis on the left side were detected. On laboratory investigations, acute phase reactants were increased. Serological study for specific antibodies against varicella zoster virus showed higher titers. Dermatology and ear nose throat specialist consultations were performed, and varicella zoster lesions on the left inner ear, face, and mild facial paresis were considered. According to clinical and laboratory findings, the patient was diagnosed with RHS triggered by tofacitinib. Tofacitinib and methotrexate were discontinued, and intravenous acyclovir was started. On the control examination, the patient's skin lesions and facial nerve paralysis regressed.

Conclusion: Herein, we reported the fırst case of tofacitinib-induced RHS in a patient with RA. This may be another side effect of biologic treatment. New studies are needed on this subject.

Keywords: Tofacitinib, ramsay-hunt syndrome, varicela zoster, rheumatoid arthritis, Lesions, rheunatology.

« Previous Next »
Graphical Abstract

[1]
Lin YJ, Anzaghe M, Schülke S. Update on the pathomechanism, diagnosis, and treatment options for rheumatoid arthritis. Cells 2020; 9(4): E880.
[http://dx.doi.org/10.3390/cells9040880] [PMID: 32260219]
[2]
Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2017; 76(6): 960-77.
[http://dx.doi.org/10.1136/annrheumdis-2016-210715] [PMID: 28264816]
[3]
Van der Heijde D, Tanaka Y, Fleischmann R, et al. ORAL Scan Investigators. Tofacitinib (CP-690,550) in patients with rheumatoid arthritis receiving methotrexate: twelve-month data from a twenty-four-month phase III randomized radiographic study. Arthritis Rheum 2013; 65(3): 559-70.
[http://dx.doi.org/10.1002/art.37816] [PMID: 23348607]
[4]
Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry 2001; 71(2): 149-54.
[http://dx.doi.org/10.1136/jnnp.71.2.149] [PMID: 11459884]
[5]
McDonald JR, Zeringue AL, Caplan L, et al. Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis. Clin Infect Dis 2009; 48(10): 1364-71.
[http://dx.doi.org/10.1086/598331] [PMID: 19368499]
[6]
Strangfeld A, Listing J, Herzer P, et al. Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents. JAMA 2009; 301(7): 737-44.
[http://dx.doi.org/10.1001/jama.2009.146] [PMID: 19224750]
[7]
Winthrop KL, Yamanaka H, Valdez H, et al. Herpes zoster and tofacitinib therapy in patients with rheumatoid arthritis. Arthritis Rheumatol 2014; 66(10): 2675-84.
[http://dx.doi.org/10.1002/art.38745] [PMID: 24943354]
[8]
Malmgaard L. Induction and regulation of IFNs during viral infections. J Interferon Cytokine Res 2004; 24(8): 439-54.
[http://dx.doi.org/10.1089/1079990041689665] [PMID: 15320958]
[9]
Paniagua R, Si MS, Flores MG, et al. Effects of JAK3 inhibition with CP-690,550 on immune cell populations and their functions in nonhuman primate recipients of kidney allografts. Transplantation 2005; 80(9): 1283-92.
[http://dx.doi.org/10.1097/01.tp.0000177643.05739.cd] [PMID: 16314797]
[10]
Nagayama Y, Matsushiro N, Nampei A, Hashimoto H, Shi K. Ramsay hunt syndrome in a patient with rheumatoid arthritis after treatment with infliximab. Case Rep Rheumatol 2014; 2014: 897647.
[http://dx.doi.org/10.1155/2014/897647] [PMID: 24660085]
[11]
Kaski D, Davies N, Seemungal BM. Varicella-zoster virus meningo-rhombencephalitis presenting as Ramsey Hunt. Neurology 2012; 79(23): 2291-2.
[http://dx.doi.org/10.1212/WNL.0b013e31827689c2] [PMID: 23212190]
[12]
Santos-Antunes J, Nunes AC, Macedo G. Ramsay-Hunt Syndrome in a patient with Crohn’s disease under adalimumab: First case report. Gastroenterol Hepatol 2015; 38(7): 443-4.
[PMID: 25081200]

Rights & Permissions Print Cite
Article Metrics
26
© 2024 Bentham Science Publishers | Privacy Policy