Successful Treatment of Multicentric Reticulohistiocytosis with Adalimumab, Prednisolone and Methotrexate.

Multicentric reticulohistiocytosis (MRH) is a rare systemic disorder belonging to non-Langerhans cell histiocytosis, which is characterized by severe destructive arthritis and multiple skin nodules. It is thought that proinflammatory cytokines, such as tumour necrosis factor-α (TNF-α), interleukin 1β (IL-1β), IL-6 and IL12 secreted by monocytes and macrophages, may be associated with the pathogenesis of skin lesions and destructive arthritis in MRH, and that the inhibition of these cytokines may be useful for therapy (1, 2). There are several case reports of successful or unsuccessful treatments using anti-TNF-α reagents, such as infliximab (3–6), etanercept (7–9) and adalimumab (10, 11). We report here a case of MRH that was resistant to combination therapy of prednisolone, methotrexate (MTX) and golimumab (another anti-TNF-α drug administrated subcutaneously every 4 weeks), but finally responded to prednisolone, MTX and adalimumab.