Rash induced by anti-tumor necrosis factor agents in an adolescent with Crohn's disease

Background. A 17-year-old white male with Crohn's disease who was receiving maintenance infusions of the anti-tumor necrosis factor (TNF) agent, infliximab, presented with a new-onset psoriasiform skin rash. The rash was not responsive to topical or oral corticosteroids and worsened after infliximab infusions and after subsequent administration of a second anti-TNF drug, adalimumab. Investigations. Full medical history and physical examination, including assessment of the morphology of rash and the temporal correlation with administration of anti-TNF agents. Diagnosis. Anti-TNF-agent induced psoriasiform skin rash. Management. Discontinuation of anti-TNF therapy. The patient opted to have his gastrointestinal symptoms treated with oral mesalazine and metronidazole.