Letters to the Editor

colitis did not overlap, pustular eruption occurred several months after colectomy and 1 month after cessation of drugs, including corticosteroid, azathioprine and tacrolimus, for ulcerative colitis. This history strongly suggests that the two diseases were associated. Our patient was treated for ulcerative colitis only once with antagonists of TNFa, 1 month before colectomy. According to a review by eHealthMe, among 10 917 people with ulcerative colitis, 7 had pustular psoriasis and females, younger than 30 years old, were preponderant. Mutation of the IL-36 receptor antagonist gene (IL-36RN) has been reported in pustular psoriasis without psoriasis vulgaris, and mutation or variants of the caspase recruitment domain family, member 14, gene (CARD14) were reported in pustular psoriasis with psoriasis vulgaris. Upon informed consent, we extracted genomic DNA from our patient’s peripheral blood and amplified exons of IL-36RN and exons 2, 3 and 4 of CARD14, including exon-intron boundaries, by the polymerase chain reaction, as described previously.3,4 Sequencing of the products revealed no mutations in either gene. Association between psoriasis and ulcerative colitis is very rare but a common pathway contributing to both diseases might exist. IL23R and IL12B might possibly be mutated genes in such a pathway.5

CONFLICT OF INTEREST:

None declared.

Kanami SAITO,1 Akiko ITO,1 Kazushi ISHIKAWA,1 Hiromitsu SHIMADA,1 Naoko TAKEO,1 Yutaka HATANO,1 Kazumitsu SUGIURA,2 Masashi AKIYAMA,2 Masafumi INOMATA,3 Seigo KITANO,3 Sakuhei FUJIWARA1 Departments of 1Dermatology, 3Gastroenterological Surgery, Faculty of Medicine, Oita University, Yufu, Oita, 2Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan doi: 10.1111/1346-8138.12629

REFERENCES 1 Shimizu A, Kamada N, Matsue H. Generalized pustular psoriasis associated with ulcerative colitis. J Clin Exp Dermatol Res 2013; 4(4): doi:10.4172/2155-9554.1000192 zquez J, Almagro M, Del Pozo J, Fonseca E. Neutrophilic pustulo2 Va sis and ulcerative colitis. J Eur Acad Dermatol Venereol 2003; 17(1): 77–79. 3 Sugiura K, Takemoto A, Yamaguchi M, et al. The majority of generalized pustular psoriasis without psoriasis vulgaris is caused by deficiency of interleukin-36 receptor antagonist. J Invest Dermatol 2013; 133: 2514–2521. 4 Sugiura K, Muto M, Akiyama M. CARD14 c.526G>C (p.Asp176His) is a significant risk factor for generalized pustular psoriasis with psoriasis vulgaris in the Japanese cohort. J Invest Dermatol 2014; 134: 1755–1757. 5 Capon F, Di Meglio P, Szaub J, et al. Sequence variants in the genes for the interleukin-23 receptor (IL23R) and its ligand (IL12B) confer protection against psoriasis. Hum Genet 2007; 122(2): 201–206.

Antitumor necrosis factor alpha inhibitor-induced dermatomyositis and interstitial lung disease with anti-PL12 autoantibody: Signs of antisynthetase syndrome Dear Editor, Cases of antitumor necrosis factor-a (anti-TNF-a)-induced dermatomyositis (DM)/polymyositis (PM) have been described.1 We report a case of anti-TNF-a-induced DM and interstitial lung disease (ILD) with anti-PL12 autoantibody as signs of antisynthetase syndrome (ASS). A 41-year-old woman was referred to us to apply an antiTNF-a agent for methotrexate-resistant rheumatoid arthritis (RA). Before injection of adalimumab, chest X-ray had not detected signs of ILD and anti-cyclic citrullinated peptide antibody had been within normal range (2.4 U/mL; normal,

Antitumor necrosis factor alpha inhibitor-induced dermatomyositis and interstitial lung disease with anti-PL12 autoantibody: signs of antisynthetase syndrome.

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