Primary cutaneous anaplastic large cell lymphoma in a patient receiving adalimumab.

ALCL: anaplastic large cell lymphoma CTCL: cutaneous T-cell lymphoma LyP: lymphomatoid papulosis PCALCL: primary cutaneous anaplastic large cell lymphoma RA: rheumatoid arthritis TNF: tumor necrosis factor INTRODUCTION Antietumor necrosis factor (TNF) agents, such as etanercept, infliximab, and adalimumab, are increasingly used in the treatment of many chronic inflammatory diseases, including psoriasis, rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, and inflammatory bowel disease. Because of their profound immunoregulatory effect, antieTNF-a agents have long been suspected to increase the risk of certain types of lymphomas, although this has never been definitively proven. To date, data from several studies and case reports have shown an increased incidence of lymphoma in patients treated with anti-TNF agents, although other reports have failed to confirm or even refute these findings. The studies lacked statistical power to quantify the incidence of a rare disease after a rare exposure. Adalimumab is a monoclonal antibody against TNF-alfa (TNF-a) and is approved for use in medical and dermatologic practice. We report a case of primary cutaneous anaplastic large cell lymphoma (PCALCL) in a patient with ankylosing spondylitis and rheumatoid arthritis treated with adalimumab.