Adalimumab-induced Cutaneous lupus in Crohn’s Disease: A Case Report

Abstract

Lupus induced by tumor necrosis factor-alpha (anti-TNFα) inhibitors is an uncommon yet well-documented paradoxical event in patients treated for inflammatory bowel disease. We describe the case of a 39-year-old woman with ileocolonic Crohn’s disease who, ten weeks after starting adalimumab, developed erythematous, scaly facial lesions suggestive of cutaneous lupus. The diagnosis was confirmed by positive antinuclear and anti–double-stranded DNA antibodies. Adalimumab was discontinued, and hydroxychloroquine therapy combined with strict photoprotection was initiated, leading to rapid lesion regression within approximately three weeks. Because disease control remained essential, biologic treatment was switched to ustekinumab, which has a low reported association with lupus-like reactions and a favorable safety profile in this context. This case underscores the need for systematic dermatologic monitoring in patients receiving anti-TNFα agents and the importance of early drug withdrawal when lupus is suspected. Prompt recognition and management generally result in favorable outcomes, while careful selection of alternative biologic therapy is essential to maintain disease control.