Vasculitis, Vitiligo, Thyroiditis, and Altered Hormone Levels After Anti-Tumor Necrosis Factor Therapy

To the Editor: A 55-year-old Israeli man with a history of psoriatic arthritis presented with vitiligo (Figure 1). He received infliximab infusions at a dose of 5 mg/kg every 6 weeks for 2 years to manage his psoriatic arthritis. Twelve weeks prior to presentation in our clinic, his physician doubled the dose of infliximab from 400 to 800 mg. After this, vitiligo appeared on the face, groin, hands, and feet over a 2-week period. The patient related that 2 years before this he received 500 mg of infliximab instead of the 400 mg dose and he then experienced areas of depigmentation, but to a lesser degree. Figure 1. A 55-year-old man with vitiligo after several months of therapy with an anti-TNF drug. Laboratory tests showed normal blood cell count, biochemistry, urine test, and complement levels. Prior to the increase of infliximab, his primary care physician noted elevated thyroid-stimulating hormone (TSH) of 5.62, suggesting early hypothyroidism. Rheumatoid factor, cardiolipin antibody, native DNA antibody, SM/RNP antibody, Scl-70 antibody, and antibodies to Ro/La were all negative. His total IgG was elevated at 2238 mg/dl. He had early evidence of gynecomastia and decreased libido, and sex steroid levels were investigated. On Day 700 several weeks after discontinuation … Address correspondence to Dr. Lahita; E-mail: r.lahita{at}att.net