[Intense pulsed light therapy for lupus pernio].

71 in 2008 in which Diaz et al 9 described a patient treated with adalimumab for rheumatoid arthritis whose lesions developed 2 months after the start of biologic treatment; and the third reported by Adenis-Lamarre et al 10 in 2009 in a patient with rheumatoid arthritis receiving adalimumab who developed skin lesions and was subsequently diagnosed with M chelonae infection. Our case differs from those described above in the duration of treatment of the patient with adalimumab (6 years) because in the other cases reported, the infection developed within a few months of the start of treatment. We are also of the opinion that our patient's osteomyelitis may also have been caused by the M chelonae infection, although this hypothesis could not be confirmed by histology or microbiology because the patient had already been receiving appropriate antibiotic therapy for 15 days when samples were obtained. In conclusion, anti-TNF therapy has been associated with opportunistic infections and patients receiving such therapy should be considered to be immunosuppressed. The risk level for infection due to nontuberculous mycobacteria in these patients is not yet known. However, the frequent presence of additional risk factors, such as concomitant treatment with other immunosuppressants (corticosteroids, methotrexate) and the underlying disease itself, make it difficult to estimate the specific weight of these new drugs in the process. Long R, et al. Anti-tumor necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. marinum infection complicating Crohn's disease, treated with infliximab. de Haas P, et al. Pulmonary Mycobacterium szulgai infection and treatment in a patient receiving anti-tumor necrosis factor therapy. Nat Clin Pract Rheumatol. 2007;3:414-9. 6. Mufti AH, Toye BW, Mckendry RR, Angel JB. Mycobacterium abscessus infection after use of tumor necrosis factor-␣ inhibitor therapy: case report and review of infectious complications associated with tumor necrosis factor-␣ inhibitor use. Unzurrunzaga A, et al. Mycobacterium chelonae infection associated with adalimumab therapy. ଝ Tratamiento de lupus pernio con luz pulsada intensa To the Editor: Sarcoidosis is a multisystem granulomatous disease of unknown etiology that affects the skin in more than 25% of patients. Lupus pernio is the most characteristic skin feature and presents as infiltrated violaceous plaques that tend to have a symmetric distribution, mainly affecting acral areas: nose, cheeks, ears, lips, and forehead. 1 Multiple treatment options are currently available, but there are refractory cases in which alternative treatments are needed. We report the case of a 54-year-old …