A Case of Scrofuloderma in a Patient on JAK Inhibitor Treatment for Rheumatoid Arthritis

Tokai J Exp Clin Med. 2024 Sep 20;49(3):101-104.

Abstract

A 78-year-old woman with rheumatoid arthritis, who was started on baricitinib five or six months earlier, was referred to our hospital due to a subcutaneous abscess in her right axilla. Contrast-enhanced chest, abdomen, and pelvis computed tomography showed subcutaneous abscesses in her right axilla and lymphadenopathy with calcification. Cultures from the subcutaneous abscess and skin biopsy specimens were positive for Mycobacterium tuberculosis. These findings led to the diagnosis of scrofuloderma associated with tuberculous lymphadenitis. She was started on an antitubercular regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol as the initial phase treatment (first 2 months), followed by isoniazid and rifampicin for 4 months (total 6 months). After 6 months of antitubercular treatment, the abscesses and lymphadenitis disappeared. Although cases of tuberculosis during JAK inhibitor treatment are rare, they are serious adverse events that require caution.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antitubercular Agents* / administration & dosage
  • Antitubercular Agents* / adverse effects
  • Arthritis, Rheumatoid* / complications
  • Arthritis, Rheumatoid* / drug therapy
  • Azetidines / administration & dosage
  • Azetidines / adverse effects
  • Drug Therapy, Combination
  • Female
  • Humans
  • Isoniazid / administration & dosage
  • Isoniazid / adverse effects
  • Janus Kinase Inhibitors* / adverse effects
  • Mycobacterium tuberculosis / isolation & purification
  • Purines / administration & dosage
  • Purines / adverse effects
  • Pyrazoles* / adverse effects
  • Sulfonamides* / administration & dosage
  • Sulfonamides* / adverse effects
  • Treatment Outcome
  • Tuberculosis, Cutaneous / diagnosis
  • Tuberculosis, Cutaneous / drug therapy
  • Tuberculosis, Lymph Node* / diagnosis
  • Tuberculosis, Lymph Node* / drug therapy

Substances

  • Janus Kinase Inhibitors
  • Antitubercular Agents
  • Sulfonamides
  • Pyrazoles
  • baricitinib
  • Purines
  • Azetidines
  • Isoniazid