Abstract
The study evaluated the course and outcome of erythema migrans in patients receiving tumour necrosis factor-alpha (TNF-α) inhibitors. Among 4157 adults diagnosed with erythema migrans in the period 2009–2018, 16 (2.6%) patients were receiving TNF-α inhibitors (adalimumab, infliximab, etarnecept, golimumab), often in combination with other immunosuppressants, for rheumatic (13 patients) or inflammatory bowel (three patients) disease. Findings in this group were compared with those in 32 sex- and age-matched immunocompetent patients diagnosed with erythema migrans in the same years. In comparison with the control group, the immunocompromised patients had a shorter incubation period (7 vs. 14 days; p = 0.0153), smaller diameter of erythema migrans (10.5 vs. 15.5 cm; p = 0.0014), and more frequent comorbidities other than immune-mediated diseases (62.5% vs. 25%, p = 0.0269), symptoms/signs of disseminated Lyme borreliosis (18.8% vs. 0%, p = 0.0324), and treatment failure (25% vs. 0%, p = 0.0094). After retreatment with an antibiotic, the clinical course of Lyme borreliosis resolved. Continuing TNF inhibitor treatment during concomitant borrelial infection while using identical approaches for antibiotic treatment as in immunocompetent patients resulted in more frequent failure of erythema migrans treatment in patients receiving TNF inhibitors. However, the majority of treatment failures were mild, and the course and outcome of Lyme borreliosis after retreatment with antibiotics was favourable.
Highlights
Erythema migrans (EM), the hallmark of early Lyme borreliosis (LB), is a distinct skin manifestation that develops at the site of the Borrelia-infected tick bite
Among 4157 adults diagnosed with erythema migrans in the period 2009–2018, 16 (2.6%) patients were receiving TNF-α inhibitors, often in combination with other immunosuppressants, for rheumatic (13 patients) or inflammatory bowel disease
Continuing TNF inhibitor treatment during concomitant borrelial infection while using identical approaches for antibiotic treatment as in immunocompetent patients resulted in more frequent failure of erythema migrans treatment in patients receiving TNF inhibitors
Summary
Erythema migrans (EM), the hallmark of early Lyme borreliosis (LB), is a distinct skin manifestation that develops at the site of the Borrelia-infected tick bite. The inoculated borreliae may disseminate from the skin to various organs, leading to different manifestations of the disease [1,2,3]. The number of immunocompromised patients has substantially increased and is linked to an augmented risk of infection. A subgroup of individuals with impaired immunity involves those receiving biological therapy with inhibitors of tumour necrosis factor-alpha (TNF-α), a proinflammatory cytokine produced by activated monocytes/macrophages and T-cells. If the immune system protecting from infection is inhibited, the risk of severe infection increases and latent infections may be reactivated [4,5,6]
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