Vol.19 No.2

Case Report

A case of peripheral neuropathy and skin ulcer in a patient with rheumatoid arthritis after a single infusion of tocilizumab

Authors

Fumiaki Sugiura1 , Toshihisa Kojima2 , Takeshi Oguchi1 , Shirou Urata1 , Yukio Yuzawa3 , Akihiro Sakakibara4 , Hiroki Hayashi3 , Norihiro Nishimoto5 , Naoki Ishiguro2

  • Department of Orthopedic Surgery, Anjo Kosei Hospital, 28 Higashihiroaze, Anjo-cho, Anjo, Aichi 466-8602, Japan
  • Department of Orthopaedic Surgery, Nagoya University School of Medicine, Nagoya, Japan
  • Department of Clinical Immunology, Nagoya University School of Medicine, Nagoya, Japan
  • Department of Dermatology, Nagoya University School of Medicine, Nagoya, Japan
  • Laboratory of Immune Regulation, Osaka University Graduate School of Frontier Bioscience, Osaka, Japan
Received:

9 May 2008

Accepted:

29 September 2008

Published online:

6 November 2008

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Abstract

We report a case of peripheral neuropathy and skin ulcer in a patient with rheumatoid arthritis (RA) who received tocilizumab. A 65-year-old woman with a 20-year history of RA participated in a tocilizumab clinical trial. She received a single dose of 8 mg/kg tocilizumab intravenously. The following day the patient started to experience numbness and purpura in all four extremities. The purpura of her left lower limb became necrotic, and a skin ulcer appeared 3 weeks later. Steroid-pulse treatment was initiated 12 weeks after tocilizumab administration, with the result that the numbness improved, and the skin ulcers showed complete epithelialization.

Key words

Tocilizumab - Rheumatoid arthritis - Skin ulcer - Peripheral neuropathy