TY - JOUR T1 - Anti-Tumor Necrosis Factor Inhibitor Therapy-induced Dermatomyositis and Fasciitis JF - The Journal of Rheumatology JO - J Rheumatol SP - 192 LP - 194 VL - 39 IS - 1 AU - GIOVANNA RIOLO AU - TANVEER E. TOWHEED Y1 - 2012/01/01 UR - http://www.jrheum.org/content/39/1/192.abstract N2 - To the Editor:In May 2010, a 36-year-old man with a history of active terminal ileal Crohn’s disease presented to the emergency department with a 3-week history of proximal lower extremity muscle weakness. Six months previously (October 2009–April 2010), the Crohn’s disease was initially treated with multiple courses of prednisone and azathioprine 250 mg daily. Despite this regimen, he continued to have extraintestinal manifestations of Crohn’s disease, including morning stiffness, polyarthralgias of the hands and feet, early satiety, and a 30-lb weight loss in 4 months. Adalimumab was prescribed for management of his Crohn’s symptoms.Prior to administration of adalimumab, laboratory investigations in March 2010 revealed erythrocyte sedimentation rate (ESR) 107 mm/h; antinuclear antibody (ANA) 1:640 in a positive homogenous pattern; positive anti-U1 RNP and negative anti-SSA/Ro, anti-SM, anti-SSB/La, anti-SCl-70, anti-Jo-1, and native DNA antibodies; rheumatoid factor (RF) 17 KIU/ml (normal 0–19); antibodies to cyclic citrullinated peptide (anti-CCP) < 8 U/ml; C3 1.46 g/l (normal 0.90–1.80), and C4 0.18 g/l (normal 0.10–0.40). Creatine kinase (CK) was normal at 118 U/l (normal 55–197).On April 20, 2010, he received an induction dose of adalimumab 160 mg subcutaneously. On May 3, he developed sudden onset of symmetrical edema of his face and neck. On May 4, he received a second 80 mg dose of adalimumab; at Week 4, a maintenance dose of 40 mg was given. His facial edema worsened after this last dose and he experienced night sweats and diarrhea. He had increasing proximal muscle weakness and myalgias of the lower extremities that interfered with mobility. He also had morning stiffness and joint swelling of his knees, ankles, wrists, and metacarpals bilaterally. At this time, his only medication was adalimumab.Repeat laboratory investigations while on adalimumab included elevated C-reactive protein (CRP) 106 mg/l and ESR 60 mm/h, RF 17 KIU/ml, anti-CCP … Address correspondence to Dr. Riolo; E-mail: 7gr8{at}queensu.ca ER -