Abatacept

Abstract

Disseminated verrucae: case report A 77-year-old woman developed disseminated verrucae during treatment with abatacept for rheumatoid arthritis. The woman presented to a clinic with multiple brownish, round lesions, which initially appeared on her genital area and gradually spread to the trunk and extremities over the previous 6 months. She had a 10-year history of rheumatoid arthritis, for which she had previously been treated with methotrexate, sulfasalazine [salazopyrin], leflunomide hydroxychloroquine and unspecified steroids; however, the inflammation was not suppressed, and deformities appeared. She subsequently developed non-specific interstitial pneumonia, and multiple complications of rheumatoid arthritis and joint inflammation soon became uncontrollable. Therefore, she started receiving abatacept [route and dosage not stated]. Thereafter, the inflammation of the lungs and joints was controlled; however, the lesions which had appeared in her genital area 6 months earlier, started to spread over her entire body. Dermatological examination (current presentation) revealed multiple, flat, reddish-brown plaques and papules in her genital region, proximal extremities, trunk and some auto-inoculated areas. Histopathological examination showed epidermal hypergranulosis, acanthosis, and papillomatous and koilocytic changes under the hyperkeratotic keratin layer. In-situ hybridisation revealed human papillomavirus-16 positivity. A diagnosis of abatacept-induced disseminated verrucae was made [duration of treatment to reaction onset not stated]. The woman’s treatment with abatacept was stopped, and she received combined cryotherapy and imiquimod. By the end of month-4, her lesions regressed, with post-inflammatory hyperpigmentation.