Nocardiosis in a patient with pemphigus foliaceus treated with rituximab.

Rituximab is a chimeric human/murine monoclonal anti-CD20 antibody. This agent is an effective therapeutic option in severe types of pemphigus. However, rituximab may cause opportunistic infections if used in immunosuppressed patients. We reported a case of diffuse Nocardia infection following rituximab treatment in pemphigus foliaceus. Rheumatoid arthritis protocol applied in our patient. Rituximab was used at a dose of 1000 mg every 2 weeks. Because the disease was not adequately controlled, rituximab treatment was administered six times every 15 days. One week after the sixth dose of the rituximab, she presented lassitude and multiple palpable masses in soft tissue of the upper extremity. Thereafter, the aspirate culture of the abscess on the left shoulder was taken and confirmed to be disseminated nocardiosis. She was treated with linezolid and meropenem for 1 month; however, amikacin was added because the patient did not respond adequately to linezolid and meropenem therapy. The patient died of cardiac arrest because of her comorbidities. In this case, prolonged administration of rituximab therapy may have caused the development of nocardiosis. Therefore, all patients should have a sensible balance of risk and benefit, considering the use of rituximab.

Relationship between helicobacter pylori infection and pityriasis versicolor: can helicobacter pylori infection be a new etiologic factor for pityriasis versicolor?

Background/aim: H. pylori has been found to be related to certain dermatological diseases. However, there is no data as yet to propose an association between H. pylori and pityriasis versicolor. In this study, we aimed to evaluate the association between H. pylori and pityriasis versicolor. Materials and methods: This was a prospective study performed in the Gastroenterology and Dermatology and Venereology departments of the Health Sciences University, Ankara Training and Research Centre. A total of 57 consecutive patients (27 pityriasis versicolor, 30 telogen effluvium) were enrolled from the Department of Dermatology and Venereology. All patients were screened for H. pylori IgG and CagA. In addition, urea breath test was carried out to detect the existence of H. pylori infection. Results: There were significantly higher rates of H. pylori positivity, H. pylori IgG in serum in the pityriasis versicolor group compared to the telogen effluvium group (P < 0.05). In addition, the number of patients with dyspeptic complaints was higher in the pityriasis versicolor group than in the telogen effluvium group. The odds ratio for dyspepsia, H. pylori positivity, and H. pylori IgG were 2.48, 1.67, and 1.78, respectively. Conclusion: In this study, we found a statistically significant relationship between H. pylori infection and pityriasis versicolor. Therefore, H. pylori eradication could be considered in recurrent pityriasis versicolor patients with dyspepsia. New studies are required to clarify the effect of eradication treatment on the clinical course of pityriasis versicolor.

The Effect of Biological Agents on Antinuclear Antibody Status in Patients with Psoriasis: A Single-Center Study.

BACKGROUND AND AIMS: Biological agents are being used as treatment of psoriasis for years. However, autoimmunity can develop after the using of these agents. Antinuclear antibody (ANA) status changes during biological therapy can be affected by certain factors including the presence of immunosuppression. We aimed to evaluate the effect of antitumor necrosis factor agents and ustekinumab on ANA status, as well as other factors leading to change in ANA status such as history of phototherapy and methotrexate combination therapy. METHODS: In this study, the laboratory findings of thirty-one patients with psoriasis who received biological agents including infliximab, etanercept, adalimumab, and ustekinumab from 2016 to 2018 managed at the department of dermatology were reviewed. The ANA status of the patients was evaluated every 2-3 months. RESULTS: Twelve (38.7%) out of the thirty-one patients developed ANA positivity during treatment. Nine patients receiving infliximab, two patients receiving etanercept, and one patient receiving adalimumab developed ANA positivity. The nuclear homogeneous, nuclear fine speckled, and nuclear large/coarse speckled were the most common patterns of ANA. A patient receiving infliximab also developed anti-dsDNA positivity. None of the patients developed drug-induced lupus erythematosus or any autoimmune diseases. Concomitant methotrexate use and phototherapy history had no effect on ANA status statistically (P = 0.240 and 0.717, respectively). CONCLUSION: The emergence of ANA positivity during infliximab therapy among all biological agents was more common. ANA positivity during biologic agents does not cause any signs and symptoms of autoimmune diseases in patients with psoriasis; thus, it can be suggested that biological agents are not major risk factors for autoimmunity.

Association of clinical properties and compatibility of the QuantiFERON-TB Gold In-Tube test with the tuberculin skin test in patients with psoriasis.

BACKGROUND: Individuals with psoriasis show conflicting responses to the tuberculin skin test (TST), a commonly used screening test for latent tuberculosis infection. An alternative to TST is QuantiFERON-TB Gold In-Tube test (QFT-GIT), an in vitro interferon-gamma release assay. This study aimed to determine the effect of the clinical properties of psoriasis (disease severity and koebnerization status) on TST results and the agreement between the TST and QFT-GIT results in psoriatic patients. METHODS: One hundred patients with mild to severe psoriasis were enrolled in this prospective cross-sectional study. Psoriasis properties, including disease severity (psoriasis area and severity index score and koebnerization status), latent tuberculosis infection risk factors, and bacillus Calmette-Guérin vaccination history, were recorded. All patients underwent a TST and QFT-GIT. TST positivity cut-off point was ≥10 mm for bacillus Calmette-Guérin-vaccinated patients and ≥5 mm for non-vaccinated patients. RESULTS: Psoriasis area and severity index scores and koebnerization status did not correlate with TST diameters. Only one of the 23 koebnerization-positive patients developed koebnerization in response to TST. QFT-GIT positivity was prominently higher in the TST-positive group, and this was the only factor that differed between the TST-positive and TST-negative groups (P < 0.001). CONCLUSION: Tuberculin skin test results were not affected by psoriasis severity or koebnerization status. QFT-GIT positivity was prominently higher in the TST-positive group (P < 0.001). Overall agreement between TST and QFT-GIT results was moderate (κ = 0.413). Concurrent negativity (44%) was higher than concurrent positivity (27%).