Diffuse large B-cell lymphoma that develops after adalimumab using adalimumab in a patient with psoriasis

Psoriasis is a polygenic, systemic inflammatory disease seen in 2% to 3% of the population and leads to a serious deterioration in the quality of life. As a result, studies on the pathophysiology of this disease have led to the development of cytokine-targeted therapies, especially the widespread use of treatments targeting tumor necrosis factor-alpha (TNF-α). The role of TNF-α in inflammation and important physiological pathways has increased safety concerns. In the literature, it has been reported that infections, cardiac failure, neurological diseases, and malignancies may develop related to the use of anti-TNF-α agents. In this case report, a 59-year-old male patient was started on adalimumab as a biological agent for erythrodermic psoriasis. Twenty-four months after starting biological agent therapy, hard nodules occurred under his skin in both the inguinal and axillary regions. The patient was diagnosed with diffuse large B-cell lymphoma based on his histopathological and laboratory examinations. This case report aims to discuss the specific malignancies that may develop from anti-TNF-α agents and the potential pathophysiological mechanisms suggested in the current literature.

Psoriazisli hastada adalimumab kullanýmý sonrasýnda geliþen diffüz büyük B hücreli lenfoma

Psoriazis toplumun %2 ile %3’ünde görülen, yaþam kalitesinde ciddi bozulmalara yol açan poligenik, sistemik enflamatuvar bir hastalýktýr. Hastalýðýn patofizyolojisinin aydýnlatýlmasý ile ilgili çalýþmalar sonucunda, sitokin hedefli tedaviler geliþtirilmiþ, özellikle tümör nekroz faktör-alfayý (TNF-α) hedef alan tedavilerin kullanýmý yaygýnlaþmýþtýr. TNF-α’nýn sadece enflamasyonda deðil, ayný zamanda önemli fizyolojik yolaklarda rol oynamasý güvenlik endiþelerini artýrmýþtýr. Literatürde anti-TNF-α ajanlarýn kullanýmýna baðlý enfeksiyonlar, kardiyak yetmezlikte artýþ, nörolojik hastalýklar ve malignitelerin geliþebileceði bildirilmiþtir. Bu olgu sunumunda 59 yaþýnda erkek hastaya eritrodermik psoriazis nedeniyle biyolojik ajan olarak adalimumab baþlanmýþtýr. Biyolojik ajan tedavisine baþlandýktan 24 ay sonra hastanýn her iki inguinal ve aksiller bölgesinde deri altýnda sert nodüller meydana gelmiþtir. Yapýlan histopatolojik tetkikler ve laboratuvar incelemeleri neticesinde hastaya diffüz büyük B-hücreli lenfoma tanýsý konulmuþtur. Bu olgu sunumu ile anti-TNF-α ajan kullanýmýna baðlý geliþebilecek malignitelerin neler olabileceði, olasý patofizyolojik mekanizmalarý güncel literatür bilgileri eþliðinde tartýþýlmasý amaçlanmýþtýr.